This book is dedicated to the memory of my father, Donald M. Barnard, MD, a
kind and wise physician, and to the participants in our research studies. I am
deeply grateful for your important contribution to this work.
“Dr. Barnard’s solid scientific work…represents a major turning point in the
treatment and outcome of diabetes. Revolutionary in its implications and
spectacular in its clarity, this book—with its simple, safe dietary approach—will
bring hope to millions.”
—Hans Diehl, DrHSc, MPH, FACN, chairman of the Lifestyle Medicine
Institute in Loma Linda, California, and director of the International
Nutrition research Foundation
“Dr. Barnard’s superb book shows us the numerous advantages of following his
nutritional program.”
—William C. Roberts, MD, editor in chief of the American Journal of
Cardiology and executive director of the baylor Heart and Vascular Institute
in Dallas
“A promising alternative dietary approach in the treatment of diabetes.”
—William E. Connor, MD, professor of medicine and clinical nutrition at
Oregon Health and Science University in Portland
CONTENTS
ACKNOWLEDGMENTS
INTRODUCTION: A NEW APPROACH TO DIABETES
PART 1. THE BREAKTHROUGH
CHAPTER 1. The New Basics
CHAPTER 2. Reversing Type 2 Diabetes
CHAPTER 3. A Revolution in Type 1 Diabetes
PART 2. THE PROGRAM
CHAPTER 4. A Powerful New Menu
CHAPTER 5. How to Get Started
CHAPTER 6. Healthful Weight Control
CHAPTER 7. How to Test Yourself and Track Your Progress
CHAPTER 8. A Perfect Diet in an Imperfect World
CHAPTER 9. Troubleshooting
CHAPTER 10. Which Supplements Should You Take?
CHAPTER 11. Exercise for the Rest of Us
PART 3. COMPLETE HEALTH
CHAPTER 12. A Healthy Heart
CHAPTER 13. Healthy Nerves, Eyes, and Kidneys
CHAPTER 14. Information for Clinicians
MENUS AND RECIPES
NOTES
ACKNOWLEDGMENTS
I would like to thank the many doctors, nurses, dietitians, and people with
diabetes who used the first edition of this book and shared their experiences
along the way. They have underscored the power of this approach and the great
need for it at a time when the causes of diabetes and the nutritional approach to it
remain only dimly understood by a surprisingly large number of caregivers and
patients.
The research that culminated in this book was a team effort. I especially want
to express my deepest appreciation to the research volunteers who put up with
many early mornings, late nights, and needlesticks in performing an important
public service. You have taught me a great deal and helped our research
immeasurably.
I greatly appreciate the support of the National Institute of Diabetes and
Digestive and Kidney Diseases of the National Institutes of Health, particularly
Sanford Garfield, PhD, and of the Diabetes Action education and Research
Foundation and its director, Pat DeVoe, RN, BSN, without which our initial
research on diabetes would not have been possible. Thank you also to GEICO
for allowing us to test this approach in the work setting in cities across the US
and to the American Diabetes Association for the opportunity to share our
findings along the way.
Joshua Cohen, MD, of the division of endocrinology at George Washington
University, was instrumental in planning and guiding our research work. David
J. A. Jenkins, MD, PhD, DSc, of the University of Toronto, is an extraordinary
mentor whose generosity with his time, knowledge, and ideas is something I
hope to pass on to other investigators.
Caroline Trapp, DNP, ANP-BC, CDE, FAANP, has applied this approach in
extraordinary ways in her clinical work and in her innovative programs with
Native Americans and, along with Meghan Jardine, MS, MBA, RDN, LD, CDE,
has educated and empowered thousands of caregivers.
Susan Levin, MS, RD, Francesca Valente, Rosendo Flores, Jill Eckart,
Suruchi Mishra, PhD, Joseph Gonzales, RD, Gabrielle Turner-McGrievy, PhD,
RD, and Lisa Gloede, RD, CDE, helped extensively in research planning and in
guiding our research participants toward more healthful ways of eating. Brent
Jaster, MD; Amber A. Green, RD; Kim Seidl, MS, RD; Trulie Ankerberg-Nobis,
RD; Dulcie Ward, RD; Jennifer Reilly, RD; and Mary Ellen Wolfe, RN, CDE,
and Robyn Webb shared their expertise and guidance with me and our research
participants. Thanks to Paul Poppen, PhD, for his expert assistance in planning
and executing the statistical analyses. Andrew Nicholson, MD, and Mark Sklar,
MD, guided our initial research on diabetes, and Larry Kushi, PhD, provided
thoughtful advice along the way. John A. McDougall, MD, and Mary
McDougall provided educational materials and wonderful recipes. Jennie Brand-
Miller, PhD, of the University of Sydney, kindly answered many questions about
her studies of the glycemic index and its use in clinical practice.
Stanley Talpers, MD, kept a watchful eye on medical issues for our
participants, and Brad Moore, MD, served as our safety officer.
Special thanks to Ernest P. Noble, MD, PhD, and Terry Ritchie, PhD, of the
University of California, Los Angeles, for their generosity and expertise in
genetic analyses. Thank you to Donald S. Karcher, MD; Terry Costa; Luce
Merino; Estela Day; Patrice Moore; and everyone at George Washington
University clinical laboratory client services.
Cael Croft provided the wonderful medical illustrations in this book.
Finally, thank you to my literary agent, Brian DeFiore, and my editor, Marisa
Vigilante, for helping to shape this book into its current form; and Bryanna Clark
Grogan for providing wonderful recipes.
INTRODUCTION
A New Approach to Diabetes
This book presents a revolutionary method for preventing, controlling, and
reversing diabetes based on important research findings that have dramatically
changed our understanding of this condition. When this book first appeared, the
idea that diabetes could improve dramatically and sometimes even go away for
all intents and purposes was a novel concept. The prevailing notion was “once
you have diabetes, you’ll always have diabetes,” and the condition just seemed
to lead to more and more complications. We have changed that scenario.
In studies by my research team, funded by the US government’s National
Institutes of Health and the Diabetes Action Research and education Foundation,
along with the work of other researchers, we have completely redesigned the
dietary approach to diabetes. If your experience with diabetes has been one of
gradually escalating medication doses, ever-increasing weight, and increasing
worry about the risk of complications, you will learn how to reverse those
trends.
We will focus on changes in your menu, not on drugs. Yes, medications often
have their role. But I would much rather help you scale back on drugs—or
eliminate them entirely. Doing that means rethinking the foods that you eat. Let
me emphasize that you will not need to cut calories, limit carbohydrates, or stick
to small portions. In fact, you can eat until you are full. If you get hungry
between meals, you are free to eat more. What we will zero in on is the type of
food you eat. That has emerged as the critical factor, as you will soon see.
A NEW IDEA
My father, Donald M. Barnard, MD, spent his entire life treating diabetes. He
grew up on a family farm in the Midwest but soon realized that the cattle
business was not for him. He decided to go to medical school, and after training
at Boston’s famed Joslin Clinic, he began work at a busy community hospital.
He became known as the diabetes expert for the surrounding area. But he and the
other doctors—and their patients—often found diabetes puzzling and frustrating.
He recounted a telling comment made by the clinic’s founder, Elliott P. Joslin,
MD, about diabetes research: “Gentlemen, we don’t need a big research grant.
What we need is a new idea.”
Dr. Joslin made that observation back in the 1950s, and the need has only
grown more urgent as the incidence of the disease has exploded. Worldwide,
more than 400 million people are living with diabetes. Until now, most have
found the condition to be at best an exercise in drudgery. With daily blood tests
and a growing list of medications that aim only to slow the disease’s inevitable
damage, a patient’s life becomes a waiting game, with one complication arising
after another—from nerve symptoms to visual changes and heart and kidney
problems.
Now, at last, we have a much more powerful approach. I’m talking not just
about a bold new idea, but about an entirely new approach to diabetes that has
been tested and proven.
In a series of research studies conducted first with Georgetown University
and George Washington University in Washington, DC, our research team has
proven that many people with diabetes can think beyond delaying inevitable
decline and improve their health dramatically. They can cut their blood sugar,
increase insulin sensitivity, and reduce or eliminate medications, and they can do
this with a simple set of diet changes. Unlike with medication treatments, the
“side effects” of the menu change are good ones: weight loss, lower cholesterol
levels, lower blood pressure, and increased energy.
From the beginning, our studies aimed higher and took a more aggressive
approach to diabetes than clinicians had in the past. The first study was small—
just 13 patients—and it tested a program that relied entirely on changes in diet.
There was no new drug, no magical supplement—not even an exercise program.
But the results were amazing. Two-thirds of patients improved so much that they
were able to reduce or eliminate their medications within 12 weeks. The study
was published in Preventive Medicine in 1999.
1
Then, in a second study, this one involving 59 patients with varying degrees
of blood sugar control—some healthy, others prediabetic or diabetic—we
studied why diet change works. It became clear that the diet shift actually caused
a fundamental change in the body itself. In 14 weeks, the diet led to a 24 percent
improvement in insulin sensitivity—that is, the body’s ability to respond to
insulin, the sugar-storing hormone that is dysfunctional in diabetes. Participants
whose blood sugar levels were in the abnormal range saw them promptly return
to where they belonged. While exercise could increase the benefits even further,
diet changes alone were powerful enough to boost insulin sensitivity and bring
blood sugar under better control. The results were presented at the American
Diabetes Association Scientific Meeting in 2004 and were published in the
American Journal of Medicine in 2005.
2
These studies suggested that this new approach may be the most powerful
nutritional plan ever devised for diabetes. We can do more than try to
compensate for malfunctioning insulin, as doctors have done for decades with
various medications. Rather, we can help the body’s own insulin work properly
again by directly addressing—and improving—the cells’ sensitivity to it, which
is the key issue in type 2 diabetes. Even when the disease has evolved to the
point of serious complications, it is not too late for marked improvements to
occur.
Starting in 2003, with the support of the National Institutes of Health, we
conducted a new research trial to compare our diet, head-to-head, against the
guidelines promulgated by the American Diabetes Association at that time.
These conventional guidelines seemed sensible and were well accepted. Millions
of people followed them, carefully cutting calories and limiting carbohydrates.
But all too often, a familiar story ensued: Despite everyone’s best efforts, the
disease typically worsened over time. Our goal was to see if we could improve
things. The study was conducted with George Washington University and the
University of Toronto and included 99 individuals with type 2 diabetes. The
participants were randomly assigned to either a standard diabetic diet based on
the 2003 ADA guidelines or to the more aggressive diet you will learn about
shortly. Along the way, I presented the study’s initial results at scientific
meetings of the ADA, the American Association of Diabetes Educators, and the
American Public Health Association.
In a careful analysis that kept exercise and medication use constant, we
found that the new diet controlled blood sugar three times more effectively than
the previous “best” diet. It also accelerates weight loss and controlled cholesterol
better than the old gold standard. Other investigators have showed that this kind
of diet also has dramatic benefits for the heart and leads to a big improvement in
blood pressure. It allows many individuals to take charge of their lives again and
to return to health and vigor.
We then ran two studies with GEICO, the insurance company, to see how it
would apply in the work setting in 10 different cities. In a word, it works great
and is easy to implement. We have also documented its efficacy against more
advanced diabetes, focusing on improvements in nerve symptoms.
This book translates these scientific breakthroughs into tools that you can
use, including an easy-to-fol low plan with simple diet guidelines.
A NEW UNDERSTANDING OF TYPE 1 DIABETES
Type 1 diabetes is much less common than type 2. It is usually diagnosed in
childhood and is invariably treated with insulin—hence its former names,
childhood-onset diabetes and insulin-dependent-diabetes.
Unlike people with type 2 diabetes, those with type 1 always need to take
insulin. But they can use diet and lifestyle changes to keep doses to a minimum
and reduce the risk of complications. We also have a new understanding of the
fundamental causes of type 1 diabetes. It may surprise you to learn that the
process that leads to type 1 diabetes begins when the body’s immune system
attacks the insulin-producing cells of the pancreas. As you will see, new research
has revealed what appears to spark this attack and what can help to prevent it.
PERSONAL SUCCESS
Let’s take a look at the experiences of real people who followed the program
described in this book.
Nancy
Nancy learned about our research study from an advertisement in the
Washington Post. She had been diagnosed with type 2 diabetes 8 years earlier. A
cousin of hers had lost some of his eyesight to the disease, and failed kidneys left
him on dialysis. Nancy did not want that to be her future. She was going to fight
back.
Before she joined our study, things had been going in the wrong direction.
Although she had followed a diet designed for diabetes, her blood sugar was
gradually worsening, and the diet did nothing to stop her weight from creeping
upward.
Two years after her diagnosis, her doctor put her on her first diabetes
medication. Eventually, her doctor felt she needed two medications. Still her
blood glucose level continued to rise. As she entered our study, her hemoglobin
A1C level—the key index of blood glucose control, which ought to be below 7.0
percent—was an unhealthy 8.3 percent.
Nancy joined the study because she liked the focus on food rather than on
drugs. With the explosion of diabetes in the population, she intuitively felt that
the problem had to be the kinds of food we eat and that the solution had to be
there, too.
We showed her how to change her diet. There were no limits on how much
she could eat or on how many calories or grams of carbohydrates she could
have. But we did ask her to make a major change in the type of food she chose.
At first, we also asked her not to exercise—that is, not to change her exercise
habits—because we wanted to see what diet changes alone could do. That suited
her just fine—she was very busy at her office, working long hours every day,
and exercise was not exactly her thing. At least not yet.
As she began to follow our recommendations, her weight started to fall,
along with her blood glucose, the latter with surprising speed. After years of
going up and up and up, the trend started to reverse. After 11 weeks, she stood
on the scale: She had lost 14 pounds. And when she rolled up her sleeve and we
checked her A1C, we found that it had dropped from 8.3 percent to 6.9 percent.
All in about 3 months’ time. Her insulin sensitivity was returning.
Nancy’s blood sugar continued to fall. In fact, it fell so much that it became
clear that her medications were now too strong for her. The combination of the
drugs she had been taking, along with the new, powerful diet changes, actually
left her blood sugar too low. It was time to reduce her medications. But as we cut
back on her doses, it turned out not to be enough. After several more months, we
had to stop one of them altogether.
A little more than a year after joining the study, she was 40 pounds lighter.
She stopped her diabetes medications, and yet her A1C is better than it was
before—6.8 percent at her last test.
“The payoff is just incredible,” she said. “But it’s not just the weight loss.
My numbers have gotten dramatically better.”
And there was more—another benefit she had not anticipated. For years, she
had had arthritis pain so severe she could not open a jar. After a few months of a
new diet, she suddenly realized that her arthritis symptoms were completely
gone. (There is actually a fascinating body of scientific literature on diet and
arthritis, which I summarized in an earlier book, Foods That Fight Pain.) The
best part of the story: Nancy’s experience is not unusual for people who make
the diet changes you will read about shortly.
Vance
Vance was just 31 years old when he was diagnosed with diabetes. He had just
changed to a new doctor, and the diagnosis came after a routine blood test. Both
of his mothers parents had had the disease, but up until that point, Vance had
been in more or less good health. He had been a police officer for 12 years and
now worked in a bank, and he was not in the habit of calling in sick.
Diabetes changed everything. “If I didn’t lose a leg or go blind, I could end
up on dialysis,” he said. And the truth was, he was not in such perfect shape. He
had gradually gained weight over the years, and at just under 6 feet tall, he
weighed 276 pounds. “I didn’t really take my diet or my health very seriously,”
he said. “I grew up on steak sandwiches, pork chops, and chicken. We had
barbecues and cookouts. We had some vegetables, but not a lot of fresh foods. I
didn’t exercise. I just didn’t take any of this very seriously.”
Along with weight problems came difficulties with sexual performance.
Impotence affects many men with diabetes and is common in men who are
overweight. His doctor started him on metformin, a commonly prescribed
medication for reducing blood sugar.
Vance learned about our research study and decided to volunteer—despite a
few misgivings about the prospect of changing his diet. “I never had any diet
restrictions or rules before,” he said. “I never tried to control my diet before. I
always ate whatever I wanted.” But his wife had been a vegetarian for some
time, and she was excited that Vance was ready for a change, too.
The payoff came pretty quickly. His weight started to fall, and over a years
time, he lost—to his surprise—about 60 pounds. His A1C, which had been 9.5
percent at the beginning of the study, fell to 7.1 percent after just 2 months.
Fourteen months into the study, it had dropped to 5.3 percent. His doctor was
thrilled and said it was time to stop the metformin.
One more surprise: His problems with sexual performance virtually
disappeared within 3 months. “I haven’t been in this good shape since I was in
the police academy. It is like a weight has been lifted off of me,” he said. “When
I told my mother what I was doing—that I had changed my diet—she was so
happy, she nearly cried, because my dad died at 30. When my grandfather died, I
was the oldest male in my immediate family. We tend to check out pretty quick.
But she saw I was on a different path. I was taking care of myself.”
SUCCESS
As soon as the first edition of this book appeared, we began to hear from many
more people who were putting this method to use and achieving surprising
results. A reader in England sent this message:
I was diagnosed with type 2 last September and was given the
standard diet/lifestyle advice by my doctor and his colleagues here in
the UK. Initially my diabetes was mild and was managed simply with
diet/exercise. With time, however, there was deterioration, requiring
stronger and stronger medication, and I began to experience the early
stages of typical diabetes complications. I was given a copy of Neal’s
book by a caring and concerned friend. I was skeptical at first because
all the (difficult to maintain) diet changes I had made to that point did
not seem to be of any use in tackling the problem. However, I
embraced the plan in the book and really began to enjoy eating the
foods recommended.
Three months after starting out on Neal’s diet, I have had my
second (since diagnosis) review. I was called into the doctors office at
very short notice with no explanation given by the administrator on the
phone, just being told that “we need to see you today to discuss your
blood results from last week.” Obviously I was anxious, to say the
least, and was quite worried just what bad news the doc was going to
deliver. The doctor called me in however to ask me what I was doing
because “your blood picture is now more normal than mine, and I
don’t have diabetes.” He then said “I can’t tell you that you no longer
have diabetes because there is no cure for diabetes, but technically, you
don’t.”
My doctor was shocked at my blood numbers; he said that the most
improvement he has ever seen up to that point was typically no more
than 5 to 10 percent in his best-managed diabetes patients. My blood
numbers were apparently more than 60 percent better than my last set
of results in January (before I started Neal’s diet). My doctor is now
recommending Neal’s diet to his other patients with diabetes.
Another reader, Patricia, was working as a defense analyst at the Pentagon.
For most of her life, she had struggled with her weight, and eventually she was
95 pounds heavier than she wanted to be. At age 58, she developed diabetes and
had blocked arteries in her heart. She was making trips to doctors’ offices much
more often than she would have liked and was taking 13 pills and two shots a
day.
But she learned about our approach and put it to work. Patricia ended up
losing 95 pounds. She got off all her diabetes medications. She has more energy
than she has had in years. Her husband followed her lead, and he slimmed down,
too. They are doing things they couldn’t do before, and they feel great.
A woman in Portland wrote that she had started gaining weight after the birth
of her second child. She worked evenings at a catalog call center, and when she
got off work, she found herself at the drive-thru on the way home, ordering
unhealthy things and more food than she needed. Over time, she gained almost
100 pounds.
That extra weight took a real toll, and it gradually robbed her of things she
loved to do. One year, her family went to Disneyland, and she found that she was
really not able to walk around the various sights. She had no energy, and her feet
hurt. After a half-hour, she was pooped, and she had to leave.
One day, the occupational nurse at work called her urgently to let her know
the results of some blood tests she had had. Her fasting blood sugar was 278,
which looked like out-of-control diabetes.
This was a major wake-up call. She was not just heavy; she was in trouble.
Well, she found information from my team about tackling weight problems
and diabetes. Our method focused on food and allowed her to eat as much as she
wanted, zeroing in on the type of food she ate. That sounded really appealing,
and she jumped in.
In the first 3 weeks, she lost 7 pounds, and her blood sugar was starting to
fall, too. After a year, she was down 60 pounds. And today she is at the weight
she wants to be.
And what about her diabetes? Well, her A1C blood test was 10.1 when she
started—that’s way into the diabetic range. But it gradually came down and
down and down, and today it is well below the diabetic range. And her
cholesterol plummeted 63 points.
And her energy is back. Remember the problems she had trying to walk
around Disneyland? Well, today she is on her feet for hours at a time, running
training courses for new employees. And she has energy to burn.
Her skin used to be blotchy and red. And now it’s back to the way it should
be. Headaches, stomachaches, and pains in her feet have all gone away, and she
feels great.
She has taken control, shedding that weight and getting her energy back. And
she loves eating healthful foods that work for her, not against her.
There are many, many more stories of great success from real people. But
now is the time for you to begin your own success story.
TAKING CONTROL
The diet embraced by Nancy, Vance, and the others you have read about here—
and that I hope you are about to begin—is designed to do much more than
simply palliate diabetes, as other diets do. It is designed to tackle the
fundamental causes of the disease.
As those who participated in our study learned, blood sugar levels that creep
steadily upward can also fall. The road to diabetes is in fact a two-way street.
Whether you have type 2 diabetes and want to gain control of your health or
have type 1 diabetes and need to reduce the disease’s intrusion on your life, this
program was designed with you in mind.
However, our research—and this book—also targets a broader purpose.
More and more people, including a surprising number of children, are diagnosed
with diabetes every day. They and their families pay a high personal price with
the condition. And clinics, health maintenance organizations, insurers, and
government programs are struggling to keep up with prescription costs, doctor
visits, and hospitalization charges for its many complications. For many people
at risk, it is simply a matter of time before they are diagnosed. It is our hope that
a new direction in diet and nutrition, if applied broadly enough, can go a long
way toward solving these problems.
This program is truly a revolution in the way we think about this otherwise
unforgiving disease. Diabetes is no longer a condition you simply have to live
with. It need not slowly and inevitably get worse. Quite the opposite. If you have
diabetes, it is time for you to get your life back.
We will not cater to your diabetes. Rather, this program is designed to help
you understand the cause of diabetes and how to correct it to the fullest extent
that diet and lifestyle changes possibly can. If you do not have the disease but
are at risk, this is a powerful program for preventing it.
“Is this program for me?” you may be asking. The answer is an emphatic
yes. Here’s why.
Whether you like to cook or prefer to eat at restaurants, you can easily
make the diet changes you need. I make this point because some people
imagine that changing their diet means making every meal in their own
kitchens. Translation: hours and hours of work. If you inwardly groan at that
thought, I certainly sympathize: I learned long ago that my temperament is
not suited to spending much time in the kitchen. Perhaps I was born with the
“room service gene,” and maybe you were, too. So I will show you how to
plan a healthful menu and how to make it work for you whether or not you
like to cook. Many of our research participants travel, eat at restaurants, or
eat in their company cafeterias. This program worked for them, and it can
work for you.
It does not matter whether you love exercise or have never been able to
stick with an exercise plan. The improvements described above were made
without exercise. In fact, our research studies typically omit exercise because
we need to isolate the effect of diet changes in order to put them to a good
test. Having said that, exercise is an important part of any diabetes treatment
regimen, and this book will show you how to bring it into your life in a
sensible, safe, and effective way. If, however, you are unable to engage in
significant exercise because of joint problems, a heart condition, or severe
obesity, or if you find you’re just not able to stick with an exercise program,
you will be glad to know that the benefits of our diet change are not
dependent on any alteration of your activity levels.
If you have felt that you just cannot stick with a diet, I completely
understand. That’s why we will focus solely on what you eat, not how
much. You can eat until you are full and have snacks when you want them.
You will have to invest some energy, however: You will have to learn to
think about food in new ways. And you will have to unlearn some old,
outdated notions. And if you have been overweight, it is very likely that you
will have to buy some new clothes!
WHAT DOES IT MEAN TO REVERSE DIABETES?
Most people with diabetes find themselves on a road leading toward gradually
increasing weight, slowly rising blood sugar, higher doses of medications, and
worsening complications. Reversing diabetes means reversing this trend. If
weight is an issue, it can come down—gradually, but decisively. Blood glucose
values that have gone up can also come down. Doses of medications that have
risen again and again can come down, too. Symptoms such as neuropathy—
nerve pain in the feet and legs—can improve and even disappear. Heart disease
can be reversed.
Will the disease go away completely? Some people would argue that once
someone has diabetes, that person will always have it, even if blood tests
improve so much that the condition is no longer diagnosable. What they mean is
that the genetic traits that made type 2 diabetes possible do not go away, and
type 1 diabetes requires continued insulin treatments regardless of how well you
adjust your diet.
It is not possible to say in advance how far you can go. Will you be able to
reduce your medication doses, eliminate some or perhaps all of your
medications, or drive your blood sugar down so far that no one would ever know
you once had diabetes? These are questions your own experience will answer,
but I can promise this book will teach you what you need to know about putting
a powerful food prescription to work. The rest of the story is yours to write.
I would be very grateful if you would let others know what you are doing
and perhaps lend this book to your friends or family members who have
diabetes. We know that we can turn this disease around for individuals, but
conquering an international epidemic is a tall order, and it requires a team effort.
I hope you will join in this important cause along with health professionals,
research participants, and their families.
Thank you, and the very best of luck with this program.
PART 1
The Breakthrough
CHAPTER 1
The New Basics
In recent years, much of what we thought we knew about diabetes has been
turned on its head. What is now coming into focus is an understanding of its
fundamental causes, and that gives us power we never had before.
To make sure we are at the same starting point, let me walk you through the
basics: symptoms, diabetes types, and typical treatments as they are currently
used. Then I will show you what’s new.
HOW DO WE KNOW IT’S DIABETES?
First, let’s make sense of the symptoms. Diabetes may arrive with no symptoms
at all, but often it starts with fatigue. For no apparent reason, your spark is just
no longer there. It may also seem that you are losing water more rapidly than
you should be, which is to say that you make trips to the bathroom more often
than usual. And you are thirsty: You find yourself drinking a surprising amount
of water.
Here is what is going on: The fundamental problem is that sugar is not able
to pass from your bloodstream into the cells of your body. From that single
problem come a great many others, like one domino knocking over another and
another and another.
The sugar we are speaking of is glucose—one of the smallest and simplest
sugar molecules. In this case, sugar is not just another word for junk food or
empty calories. The fact is that the cells of your body use this kind of sugar—
glucose—as an energy source. Like gasoline for your car or jet fuel for an
airplane, glucose is your body’s fuel. It powers your movements, your thoughts,
and more or less everything you do.
And that is exactly the problem. If glucose is unable to enter your cells, they
are deprived of their basic fuel, so you lose your energy. That is why you are
fatigued. If your muscles do not have the glucose they need for power, you tire
easily.
Meanwhile, the glucose that cannot get into your muscle cells builds up in
your bloodstream. It becomes more and more concentrated in the blood, and
eventually it starts to pass through the kidneys and ends up in your urine.
*
Now, as glucose passes through your kidneys, it carries water along with it—
lots of water, hence all those trips to the bathroom. What follows, naturally, is
thirst—you are losing all those fluids. So fatigue, frequent urination, and thirst
are all symptoms of one problem: glucose is having trouble getting into your
cells.
You may also find that you are losing weight. And no, this is not an
especially welcome event—not in this situation. You lose weight because your
cells are in essence starving. Nutrients cannot enter your cells, so your body is
malnourished. Yes, even if you are eating plenty of food, nutrients and fuel are
unable to get where they are needed.
Every day, people arrive at doctors’ offices complaining of fatigue, frequent
urination, thirst, and sometimes unexplained weight loss. The doctor takes a
blood sample, finds an unusually high level of glucose in the blood, and
diagnoses diabetes. The doctor then advises the patient that it is essential to get
blood sugar under control. An overly large amount of glucose flooding through
the bloodstream day after day can harm the arteries. Left unchecked, it can
damage the heart and the delicate blood vessels of the eyes, kidneys, and
extremities.
But as we have shown in our research studies, the road to high blood sugar is
a two-way street. When you change your diet and make other healthful
improvements, a rising glucose level can fall. Sometimes the change can be so
dramatic that no doctor looking at you afterward would ever guess that you had
once been diagnosed with diabetes.
How Doctors Diagnose Diabetes
Doctors diagnose diabetes if:
Your blood glucose level is 126 mg/dl (7.0 mmol/l)* or higher after an 8-hour fast.
Your blood glucose is 200 mg/dl (11.1 mmol/l) or higher after a 2-hour glucose tolerance
test. This is a test in which you drink a syrup containing 75 grams of glucose, and your
blood glucose value is measured.
Your A1C blood test is 6.5 percent or higher. A1C is a test that reflects your blood sugar
control over the preceding 3 months or so, unlike a blood glucose test, which will tend to
rise and fall from minute to minute under the influence of foods, physical activity,
medications, stress, and other factors. What the A1C test actually measures is how much
glucose has entered your red blood cells and become stuck to hemoglobin. If you have had
a lot of glucose in your blood, a fair amount of it gets into your cells and sticks to your
hemoglobin.
*US medical laboratories measure glucose in milligrams per deciliter (mg/dl). In most other
countries, glucose is measured in millimoles per liter (mmol/l). As you will see, the same
units are used in cholesterol measurements.
Diabetes Types
A diagnosis of diabetes—or prediabetes—means the insulin in your body is not
doing its job adequately. Insulin is a hormone that moves sugar from your
bloodstream into the cells of your body, among other functions. It acts like a key,
opening a door to the cell, so to speak, and allowing nutrients inside. When
insulin arrives at the cell’s surface and opens the door, glucose is able to enter
the cell, which uses it for power.
If for some reason your body is not making insulin, the result is rising blood
glucose levels. Similarly, your blood glucose rises if your cells resist insulin’s
actions—the key goes in the lock, but the door will not open.
Diabetes comes in three main types, called type 1, type 2, and gestational
diabetes, plus some variants you may need to know about. Let’s look at each
one.
Type 1 diabetes usually manifests in childhood or young adulthood. It used
to be called childhood-onset or insulin-dependent diabetes. In type 1 diabetes,
something has damaged the pancreas’s ability to produce insulin, and you need
to get it from an outside source—typically by injection. However, research has
revealed a great deal about how diet changes can reduce the risk that diabetes
will bring any serious complications your way, as you will see in Chapter 3.
In addition, we know more than ever about the causes of the disease, arming
us with more power to prevent it. The damage to the insulin-producing cells is
caused by the biological equivalent of “friendly fire.” That is, it is caused by the
body’s immune system—our white blood cells that are supposed to fight bacteria
and viruses. These cells ought to protect you, but instead they have attacked the
cells of the pancreas, destroying its ability to produce insulin. In Chapter 3, we
will look at what triggers this process. It may surprise you to learn that foods—
particularly the foods infants are fed within the first months of life—are leading
suspects.
When type 1 diabetes manifests in people who are beyond early adulthood,
the term latent autoimmune diabetes of adults (LADA) is sometimes used. But
the disease is still type 1 diabetes.
Type 2 diabetes used to be called adult-onset diabetes, or sometimes non-
insulin-dependent diabetes. About 9 out of 10 people with diabetes have type 2.
Most people with this form of the disease still produce insulin; the problem is
that their cells resist it. Insulin tries to bring glucose into the cells, but the cells
respond like a door with a malfunctioning lock. In response to these sluggish
cells, your body produces more and more insulin, trying to overcome the
resistance. If the body’s insulin supply cannot overcome the resistance, glucose
simply builds up in your blood.
Diabetes drugs work to counteract this problem: Some make your cells more
responsive to insulin. Others cause your pancreas to release more insulin into the
bloodstream or block your liver from sending extra glucose into the blood.
Until now, most diabetes diets have tried to compensate for the cells’
resistance to insulin’s action, too. They limited the amount of sugar in your diet.
They have also limited starch (complex carbohydrate) because starch is actually
made from many glucose molecules joined together in a chain. During digestion,
starch breaks down to release natural sugars into the blood. The idea is that if
you do not get too much carbohydrate at any one time, your cells will not be
overwhelmed with too much glucose. For people on medications, typical diet
plans have aimed to keep the amount of sugar or starch fairly constant from meal
to meal and from day to day so the amount of medication required to help your
body process glucose—your daily dosage—can stay the same, too. In short,
these diets have guided you on what, when, and how much to eat.
New research has changed everything, however. We can now use diet
changes to influence insulin sensitivity directly. So, as you will see shortly, the
nutrition prescription has been completely rewritten to take advantage of this
new understanding.
Gestational diabetes is similar to type 2 except that it occurs during
pregnancy. While it typically disappears after childbirth, it is a sign of insulin
resistance, and that means that type 2 diabetes may be around the corner. With
the same sorts of steps that tackle type 2 diabetes, we can often stop gestational
diabetes from ever turning into type 2.
Maturity Onset Diabetes of the Young (MODY). Rarely, a genetic
characteristic can cause the pancreas to produce insufficient insulin. The gene is
typically dominant. The affected individual is very likely to develop high blood
sugars, even though he or she may not be overweight or have insulin-resistant
cells. Because the pancreas continues to produce some insulin, insulin injections
may not be needed. The treatment is similar to type 2.
Prediabetes is the term used when your blood glucose level is higher than
normal, but not high enough for a diagnosis of diabetes. For most people, it
means that you have insulin resistance and are on your way to developing type 2
diabetes, unless you take steps now to improve your health, especially through
changes in your eating habits. This term applies when:
Your fasting blood glucose level is between 100 and 125 mg/dl (between 5.6
and 6.9 mmol/l).
Your blood glucose is between 140 and 199 mg/dl (between 7.8 and 11.1
mmol/l) after a 2-hour glucose tolerance test.
Your A1C blood test is between 5.7 and 6.4 percent.
The good news is that the same steps that help people tackle type 2 diabetes
are also effective for helping people with prediabetes to improve, often
decisively.
Insulin is made in the pancreas, an organ located just behind your stomach that is about the size
and shape of a TV remote control. In fact, remote control is what the pancreas is all about. It
sends insulin into the bloodstream to travel to the cells of your body to help them take in glucose
from the bloodstream. In type 1 diabetes, the pancreas has stopped making insulin. In type 2 and
gestational diabetes, the pancreas is usually able to make insulin, but the body’s cells resist its
action.
GENES ARE NOT DESTINY
Diabetes runs in families, but don’t take that to mean that if one of your parents
has diabetes, a similar diagnosis has to be your fate as well. You can change
things.
Let’s take a look at type 1 diabetes first. Many children are born with genes
that make it possible for them to develop type 1 diabetes, but most of them never
do. In fact, even among identical twins, when one twin has type 1 diabetes, the
other has less than a 40 percent chance of having it.
1
What makes the difference,
apparently, is the environment, particularly the foods the child is exposed to
early in life (e.g., cow’s milk); viral infections; and perhaps other factors.
Genes play a similar role in type 2 diabetes. Many years before diabetes ever
manifests, special tests can detect insulin resistance in young adults who have
inherited a tendency toward type 2 diabetes from their parents. If they eat the
same kinds of foods their parents did, they are very likely headed for a diagnosis.
Abundant evidence shows, however, that changes in diet and lifestyle can cut the
odds that diabetes will occur. When it does occur, diet can dramatically alter its
course.
The point is this: Some genes are dictators, and others are not. The genes for
hair color or eye color, for example, really are dictators. If they call for you to
have brown hair or blue eyes, you can’t argue. But the genes for diabetes are
more like committees. They do not give orders; they make suggestions.
If our genes call for diabetes, we do not necessarily have to listen to them.
We have more control than you might imagine.
EATING PATTERNS FOR DIABETES
If you have diabetes, chances are you were given printed guidelines on what to
eat and what to avoid. Perhaps you have met with a dietitian, and you may have
been referred to a diabetes class. If you are like many people, you may have
found your diet tough to sustain.
For many years, diets for people with diabetes were designed to provide
basic nutrition while also keeping calorie intake and food choices reasonably
stable over the course of the day and from one day to the next, as you saw above.
The idea was that if you had no carbohydrates for breakfast but then had a big
carb-fest later in the day, your blood sugar would change erratically. Similarly, if
you had lots of starchy foods on Monday but went low-carb the rest of the week,
your blood sugar would be all over the map, and your medications could not
keep up with you.
That approach sounds logical, but it was devised before the causes of insulin
resistance were known and has turned out to be of limited value. Many people
have trouble sticking with it. Now that we understand more about what is
happening inside your cells to cause diabetes, we can choose foods more
strategically. That means diet changes that are simpler and more effective, as you
will see in the following chapters.
The American Diabetes Association now gives a thumbs-up to several
different eating patterns, including vegetarian and vegan diets, the semi-
vegetarian “DASH diet,” low-fat diets, low-carbohydrate diets, and
“Mediterranean diets.” However, we now have good scientific evidence that
allows us to see which diet changes really work best over the long run, and soon
you will be putting that power to work.
DRUGS AND MONEY
The diet changes you will read about in this book are powerful. Unfortunately,
the power of nutrition is neglected in many medical practices, and in the process,
diabetes treatment is reduced to a series of prescriptions.
Don’t misunderstand me. Diabetes medications can be lifesaving. They can
reduce your blood sugar and, over the long run, cut your risk of complications.
And if diet and lifestyle changes do not do the job, it can be a serious mistake to
forgo medications. But some doctors and patients view medications as the only
tools at their disposal. The marketing of pharmaceuticals has so dominated
medical practice that many doctors give little more than lip service to diet and
exercise, which can often be dramatically effective.
Open any diabetes journal and you will see expensive advertisements for this
drug and that drug.
If you were to leaf through the mail that floods doctors’ offices, you would
see information about medical courses, symposia, and online educational
programs, all paid for by drug companies trumpeting their products. These
companies cater full dinners to lure doctors to presentations about one or another
application of their drugs. While many doctors find such events distasteful, they
are required to attend medical courses to maintain their hospital or university
affiliations, and drug companies have cornered the medical education market.
At the ADA annual meeting, drug company representatives arrive at the
loading dock looking as if they are preparing to put on an enormous political
convention. They erect huge display booths costing hundreds of thousands of
dollars staffed with armies of sales personnel ready to provide gifts, food,
musical entertainment, and trinkets of all kinds, all designed to woo the
clinicians in attendance.
And, of course, drug companies target consumers directly. Turn on a
television in any American city, and you will soon be inundated by commercials
asking you to speak with your doctor about all manner of medications. They
make diabetes sound almost like fun, and their latest products add to your
modern lifestyle.
You, the drug consumer, are stuck with the bill for all this. A typical diabetes
pill contains a few cents’ worth of active medication, but the retail cost is heavily
inflated by its manufacturers promotional expenses and its continued efforts to
find yet another pill that can carve out more of the market share.
The diabetes business is not limited to drugs. Patients need to buy glucose
testing equipment, too. While glucose meters are not terribly expensive,
manufacturers charge a small fortune for the supplies that go with them, much
like the shaving-product companies that give away free razors to sell expensive
blades. The test strips that fit into a typical glucose meter cost about $1 each, and
a person might use anywhere from one to eight strips per day. Add up the costs
of doctor visits, laboratory tests, medication, and glucose monitoring equipment,
and diabetes becomes a phenomenally expensive disease.
It is my hope that as the power of nutritional changes is more fully
appreciated, the commercial aspects of diabetes will take a backseat. The US
government has already invested in research on diet and diabetes, and that
investment will continue to pay important dividends. We must also turn our
attention to putting what we have learned about nutrition to work. That means
encouraging doctors to focus on diet first, pushing insurers to cover dietetic
counseling for patients and their families, educating parents about nutritional
approaches to help prevent type 1 diabetes in their children, and working with
schools to serve healthful meals so children are not sent down the road to
overweight and diabetes, as a great many currently are. These measures could
control the so-called diseases of affluence far more effectively than doctors are
able to at present, dramatically reducing the need for medications in the first
place.
Each person with diabetes has a unique ability to heal and return to health.
This ability differs from one person to the next, but in our studies, we have not
seen age, weight, or any other factor to be a barrier to improvement.
The remainder of this book will show you what I believe to be the most
powerful dietary approach to diabetes that is currently known.
*
The passage of glucose from the bloodstream into the urine led to the technical name doctors use for
diabetes: diabetes mellitus. Diabetes comes from a Greek word meaning “to pass through,” and mellitus is
the Latin word for “honey” or “sweet.”
CHAPTER 2
Reversing Type 2 Diabetes
Remarkably, my research has shown that it is possible to reverse diabetes—to
decrease blood sugar, medication doses, and the risk of complications—and this
chapter will show you how, using surprisingly simple diet changes. I will also
share some surprising new findings about the causes of type 2 diabetes—
changes inside your body’s cells that can be detected years before diabetes starts.
Evidence suggests that switching to a healthier diet has a powerful influence on
the workings of your cells, as you will see.
All doctors and dietitians recognize that if you have diabetes, your body does
not process sugar very well, which is to say that the amount of sugar in your
bloodstream is too high. Researchers learned long ago that if it stays high, you
are at risk for many health problems down the road.
To lower your blood sugar, most medical professionals are likely to prescribe
a diet that includes very little sugar. They will also ask you to limit starchy foods
—such as bread, potatoes, rice, and pasta—because in your digestive tract,
starch breaks apart to release sugar (that is, glucose). It seems to make sense—if
your body cannot handle sugar, you have to be careful about eating too much
sugar and anything that turns into it. Your medical team will also encourage you
to space out your intake of starches and sugars throughout the day—and from
one day to the next—so that it stays fairly even over time. Diabetes diets also
generally cut calories to help you lose weight and limit certain fats to reduce the
risk of heart disease and other complications. That, in a nutshell, is a typical
“traditional” diabetes diet.
It is certainly logical, and some people greatly benefit from following it. The
problem is that for most people, this sort of diet change has only a very limited
effect. Weight loss is usually modest, and the diet alone typically is not enough
to bring blood sugar under control.
Sooner or later, you and your doctor are likely to decide that the “diabetes
diet” is not helping very much, and your doctor will add various drugs. You may
need one, two, or even three different oral medications. Eventually, your doctor
may consider adding insulin injections. And because many people with diabetes
also have high blood pressure or high cholesterol levels, doctors often add
medications to tackle these problems, too. Instead of helping you reduce or avoid
medications, the diet seems to be a stepping-stone on the way to an ever-
increasing list of drugs.
The first glimmer that there might be a better way came from a look at the
prevalence of diabetes around the world. Large population studies showed that
diabetes was rare in Japan, China, Thailand, and other Asian countries. It was
similarly rare in parts of Africa.
These studies also showed something else: People in countries where
diabetes was uncommon were not following anything like a “diabetes diet.”
They did not avoid carbohydrates; they ate starchy foods every day. In Asia and
Africa, rice and other grains, starchy vegetables, bean dishes, and noodles are
staples. In fact, researchers found that people in these countries ate considerably
more carbohydrates than North Americans or Europeans do, yet diabetes was
relatively rare. So were weight problems. While obesity is found in more than 30
percent of American adults, it occurred in less than 1 percent of Japanese adults
following a traditional diet. Heart disease and several forms of cancer were rare,
too. Longevity among Japanese adults was better than that of North Americans
or Europeans.
That is, until they moved to Vancouver—or Seattle, Chicago, Atlanta, or
Washington, DC. For a Japanese adult, a move to North America dramatically
increased the risk of diabetes. Heart disease, obesity, and other problems became
much more common, too.
Now, if you are worrying that I am going to ask you to adopt a traditional
Japanese diet, relax. That’s not a bad idea, but it is not what this book is about. I
raise this international comparison simply to make an important point:
Carbohydrates do not cause diabetes. And a diet that focuses on keeping
carbohydrates out of your diet is not a powerful way to manage—let alone
reverse—the disease. If anything, healthy complex carbohydrates help prevent it.
Think about what happens when an Asian man or woman switches to a
Western lifestyle. Hamburgers, fried chicken, cheese, and other Western fare
come into the diet, while rice and noodles are gradually forgotten. The diet
becomes fattier and much higher in protein, while carbohydrate-rich rice and
noodles and other starchy foods fall by the wayside.
Tragically, that is exactly what is happening. What’s more, Asian men and
women need not leave home for these changes to occur. McDonald’s has come
to them; Burger King, KFC, and other Western eating habits have also invaded
Asia. Meat, cheese, and other greasy foods are displacing rice and vegetables.
As the Japanese diet has become Westernized, the prevalence of diabetes has
exploded. In studies of adults in Japan over age 40, diabetes prevalence was
between 1 and 5 percent prior to 1980. By 1990, it had gone up to 11 to 12
percent.
1
Statistical projections suggest it will rise even further. It turns out that
the genes that allow diabetes to occur are surprisingly common among the
Japanese, but as long as they stuck to their rice-based traditional diet, the disease
was mostly held in check. The diabetes genes lay dormant, like seeds on dry soil.
Once rice fell out of fashion and Western eating habits took hold, the genetic
traits started to show themselves.
So, if people in Asia or Africa who eat lots of carbohydrates have very little
diabetes, and if the disease becomes more and more common as carbohydrates
are excluded from the diet, researchers have had to conclude that a high-
carbohydrate diet is not the cause of the disease. In fact, the culprit seems to be
lurking in our Western diets.
The inescapable fact is that the problem is not carbohydrates (that is, sugar
and starch). The problem is in how the body processes them. If we can repair
your body’s ability to absorb and use carbohydrates, not only can you enjoy
healthy carbohydrate-rich foods without worry, but diabetes itself ought to
improve—perhaps even go away.
A look inside your body will show you what I mean.
A LOOK INSIDE YOUR BODY
Your pancreas, an organ in your abdomen, produces insulin. As you know by
now, insulin is a hormone, and the pancreas sends it into your bloodstream to
travel to the various cells of the body. Like a key sliding into a lock, insulin
attaches to a receptor on the cell’s surface and causes the cell membrane to
permit glucose to enter. Insulin does the same thing for the next cell, and the
next, and the next. It attaches to a receptor on the cell’s surface, opens the door,
and ushers glucose in.
In type 2 diabetes, this system does not work properly. Your pancreas makes
insulin, and insulin travels to each cell, but when it arrives, it has trouble
opening the door. It is as if the lock has somehow become jammed, and the key
no longer works. This is insulin resistance. Yes, the insulin “key” is there, but it
has trouble doing its job. Glucose cannot get into the cells, and it builds up in the
bloodstream.
Imagine the workings of a lock on a typical door. What if someone were to
jam chewing gum into the lock? There is nothing wrong with your key and really
nothing wrong with the lock except that it is now filled with gum. To make it
work again, we need to clean it out.
The new approach to diabetes is based on cleaning out your biological locks.
Our goal is to help your insulin “key” work the way it is supposed to.
THE NEW DIABETES DIET
As far back as the early 1900s, researchers were adjusting people’s diets to try to
improve insulin sensitivity.
2, 3
Over the years, many—like me—have been
inspired by the fact that foods that are commonly eaten in Asia or Africa
somehow help prevent diabetes.
In 1979, researchers at the University of Kentucky studied 20 men with type
2 diabetes, all of whom had been taking an average of 26 units of insulin per day.
The experimental diet included plenty of vegetables, fruits, whole grains, and
beans, so it was high in fiber and carbohydrate. The diet was nearly vegetarian,
with very little animal fat—in fact, very little fat of any kind.
After just 16 days on the program, more than half of the men were able to
stop taking insulin entirely, and their blood sugar levels were lower than before.
4
For the remaining men, insulin doses were cut dramatically. That was an
amazing and rapid result. But the study was short, and the participants lived on
the research ward for its duration. It was unclear whether a similar result would
be seen in people living on their own and preparing their own meals and whether
it would be sustained over the long term.
A study conducted at the University of California, Los Angeles—197 men
enrolled in a 3-week diet change and exercise program—showed much the same
thing. Of this group, 140 were able to discontinue their medications.
5
That was a
great result, and it occurred very quickly. The study’s limitation from our point
of view was that it could not separate the effects of diet from those of exercise.
Both are important, of course, but if we want to track down the best diet for
diabetes, it is important to keep everything else constant while the diet is being
tested.
Several years ago, my research team began a series of studies to see what
diet alone could do. We tested a diet that focused not on limiting carbohydrates
but rather on getting as much fat off the plate as possible. We thought if we
could do that, perhaps we could clean out the “lock” mechanism that opens the
cell doors.
We began with a small pilot study, which I mentioned briefly in the
Introduction. Most of the participants were surprised to see rice, pasta, sweet
potatoes, and beans on the menu and even more surprised that the diet did not
limit carbohydrates at all. No matter how long they had had diabetes or how
nervous they felt about the idea of putting carbohydrates back onto their plates,
we put no limit on carbs at all.
There was also no limit on portions. Most of our participants were
overweight, but even so, we did not ask them to limit portions or cut calories.
What we zeroed in on was fat. We aimed to clean all the grease out of the
participants’ diets. So, instead of bacon and eggs for breakfast, they had to
choose from old-fashioned oatmeal, half a cantaloupe, or whole grain toast. If
they had chili for lunch, it was veggie chili. Instead of pasta topped with meat
sauce, they got meatless marinara. For the duration of the study, we asked them
to set aside animal products completely and stick to vegetarian foods.
Needless to say, if there are no animal products in the diet, there is not a
single drop of animal fat. We kept the use of vegetable oils as minimal as
possible, too. And, in order to isolate the effects of the diet, we asked the
participants not to alter their normal activity patterns; no one was to add exercise
to the regimen. Now, exercise is an important part of any healthy lifestyle, and
ordinarily we would strongly encourage it. But this was a test of the diet alone,
and for scientific reasons, exercise was not to be part of it.
At the end of the study period, everyone weighed in. In just 12 weeks, the
average participant had lost 16 pounds. Their fasting blood sugar had dropped 28
percent. Two-thirds of the participants on diabetes medications were able to
reduce or discontinue them in that short period of time.
6
All this occurred
without any limits on calories, portions, or carbohydrates and without exercise.
These effects were significantly greater than those seen in a control group
carefully following the diet guidelines of the American Diabetes Association
(ADA).
That was impressive. But why did it happen? How does a diet that gives a
green light to pasta, rice, and all the other foods that people with diabetes
thought they had to live without—and one that completely disregards calories
and avoids exercise—cause blood sugar to plummet and weight to easily drop
away?
To answer that question, we designed another study. This one included a
group of women who were moderately or severely overweight but did not have
diabetes. Once again, we zeroed in on animal fat and vegetable oils. Our
participants set animal products aside and kept oils to a bare minimum. And they
were free to implement the diet guidelines in their own way, whether they ate at
home or ate out, so it was a good test of how the diet would work in real life. For
one person, eating out might have meant mushroom stroganoff with steamed
vegetables; for another, it might have been vegetable sushi with miso soup and
salad. As long as they avoided animal products and kept oils to a minimum, they
were free to shape their meals to their liking.
For comparison, we included a control group whose members followed what
you might think of as a typical cholesterol-lowering diet. It cut back on red meat
while emphasizing poultry and fish along with plenty of vegetables, fruits, and
whole grains.
The results were quick and impressive. The vegetarian group participants
lost about a pound per week; after 14 weeks, they had lost an average of 13
pounds, compared to 8 pounds for the control group.
7
by now, it was no surprise that this diet causes weight loss, but we went a
step further. We sent our participants to the laboratory for a glucose tolerance
test, which allowed us to measure how their bodies responded to sugar and how
well their bodies’ insulin was working. Each participant swallowed a dose of
sugary syrup, and we took blood samples every half hour to measure rises in
blood sugar and insulin. From these laboratory data, we were able to calculate
each woman’s insulin sensitivity and track how it changed as the study
progressed.
The results were remarkable. The tests showed that our participants were
physically changing. Based on their laboratory measurements, it was clear that
their bodies’ cells were becoming more and more sensitive to insulin. By the 14-
week point, their insulin sensitivity had improved by 24 percent. In other words,
something about the diet reactivated their natural insulin’s ability to open cell
doors to glucose. What that means, of course, is that the diet was addressing the
fundamental problem we see in type 2 diabetes: It was helping glucose get to
where it belonged.
*
Based on these and other studies, the National Institutes of Health—the
research branch of the US government—decided to fund a new study.
8
Working
with me on the project were researchers from George Washington University
School of Medicine and the University of Toronto and dietitians and physicians
working with the Physicians committee for Responsible Medicine, a nonprofit
organization I founded in 1985.
The study included 99 people with type 2 diabetes. For 22 weeks, 49 of them
followed a diet that was similar to those we had tested earlier. The diet was
vegan—meaning that it included no animal products at all—and was low in fat.
Also, while we placed no limits on the amount of carbohydrates our participants
could have, we encouraged everyone to be selective about the kinds of
carbohydrates they ate. Instead of white bread, we encouraged them to choose
rye or pumpernickel. Instead of baking potatoes, we favored sweet potatoes and
yams. The remaining 50 participants followed a diet based on the ADA
guidelines. Once again, we restricted exercise.
What was happening was that the diet had made their cells more sensitive to
insulin’s action, so they were able to take in nutrients more quickly. Glucose got
out of the blood and into the cells, where more of it could be burned up, so to
speak. These calories are released as body heat rather than being stored as body
fat. Scientists call this the thermic effect of food, and it provides a small extra
edge for weight loss.
Over the ensuing weeks, many participants found their blood sugar falling to
the extent that they had to cut back on their diabetes medications. That was a
happy outcome, but it was not our goal. In fact, we were trying to keep
medications unchanged as much as we could so we could isolate the effect of the
diet on their blood sugar. The combination of the diet and the blood sugar–
lowering drugs was so powerful, however, that many participants had to reduce
their doses or discontinue medications altogether to keep their blood sugar from
dropping too low.
To really gauge what the diet could do, we looked at those participants
whose medications had stayed constant and how the diet affected A1C—the
principal gauge of blood glucose control. The ADA diet had reduced A1C by 0.4
percentage point—a good change. But the vegan diet was three times more
effective. It had reduced A1C by 1.2 percentage points (the average person’s
value fell from 8.0 to 6.8 percent during the 22-week study). That is a stronger
effect than is seen with a typical diabetes medication. The vegan diet also proved
highly effective in reducing body weight and cholesterol.
To put all this in perspective, the landmark UK Prospective Diabetes Study
showed that a 1-point drop in A1C for people with type 2 diabetes lowers the
risk of eye or kidney complications by about 37 percent.
10
This is the effect of
just the A1C drop without considering the ability of the diet to also reduce
cholesterol and blood pressure.
11
In the next chapter, I will show you how you can test this diet to see what it
can do for you. But let’s look a bit closer at the science behind this approach.
TOWARD THE PERFECT DIET
Setting aside animal products and keeping oily foods to a minimum may sound
challenging, but our participants commonly reported just the opposite. One man,
Walter, said, “I’m amazed at how easy it was to adapt to this diet. And I feel
great. Within 2 months, I lost 20 pounds. And the more amazing thing to me is
that my glucose averages have fallen by 30 to 40 points.”
For Mark, the change was “an adventure. I tried new restaurants, new
recipes, and different foods I would never have eaten before. My main goal was
to lose weight, and I’ve lost a good 30 pounds so far. When I started, my fasting
blood sugar was 260 to 360. And it dropped like a rock. Now I’m between 130
and 135. And I don’t get tired in the afternoon like I used to.”
Nancy agreed. She felt totally adjusted to the diet within about 30 days.
“And within 5 months of making the change,” she said, “my blood sugar fell so
much that I was able to stop one of my medications. I have much more energy
and really feel tremendous.”
I will walk you through the diet step by step. If it sounds like a very healthful
diet, it certainly is—and not just for controlling blood sugar.
In 1990, Dean Ornish, MD, a young Harvard-trained physician, discovered a
remarkable feature of a low-fat, vegetarian diet. He tested the diet in individuals
with heart disease and added other healthy lifestyle changes—regular exercise,
stress modification, and smoking cessation. Because the diet contained no
animal products, it had no cholesterol at all and very little fat. After a years
time, each patient had a special x-ray of the heart called an angiogram, and Dr.
Ornish’s team compared the results with angiograms done on the same patients
at the beginning of the study. The results made medical history. The patients’
coronary arteries, which had been blocked by years of poor diet, were actually
starting to open again. The difference was clearly visible in 82 percent of the
patients after 1 year. This occurred without surgery or drugs—even without
cholesterol-lowering medication.
12, 13
Other researchers have shown that this same sort of diet change reduces
blood pressure. Apparently, eliminating animal fats reduces the viscosity
(“thickness”) of the blood. That is, the blood becomes less like grease and more
like water, so it easily flows through the arteries, causing blood pressure to fall.
Blood pressure is also reduced by the potassium in vegetables and fruits, and
other characteristics of plant foods augment this benefit.
14
Vegetarians are slimmer, too. The average person who embraces a vegetarian
diet loses about 10 percent of his or her body weight.
These changes would be welcomed by most of us, but if you have diabetes,
they can be lifesaving. This is because, as you saw in Chapter 1, persistently
high blood sugar can attack the blood vessels of your heart, eyes, kidneys, and
legs. What kills most people who have diabetes (that is, those who have not
made the diet changes you are reading about) is damage to their hearts. A diet
that reverses that process—turning the clock backward on heart disease,
reducing blood pressure, and trimming weight—is powerful medicine for
everyone with diabetes, whether type 1 or type 2.
Imagine if your eyes were damaged by the disease. An ophthalmologic
surgeon, laser in hand, would carefully try to repair your tender retinas. But what
if foods could help avert this damage in the first place? A diet change that brings
your blood sugar under control, brings your blood pressure down, and helps
rejuvenate your arteries gives a measure of respite to the tiny blood vessels in
your eyes. It does the same for the tiny vessels that make up the filtering unit in
your kidneys, making it less likely that you will ever need dialysis. And of
course, it works powerfully inside the heart.
Now, do not misunderstand me. I am not suggesting that you should forgo
needed medical treatments and rely on diet alone. But a diet change—if it goes
far enough and begins early enough—can revolutionize your health, dramatically
cut your risk of complications, and even reverse these complications to a degree.
INSIDE THE CELL
In discussing type 2 diabetes, I have described each cell of the body as being
rather like a gummed-up lock. Research has shown this analogy to be
surprisingly apt. Indeed, insulin’s ability to work is blocked by the accumulation
of something within the cells: not gum, but fat.
In the February 12, 2004, issue of the New England Journal of Medicine,
Yale University researchers reported an amazing discovery.
15
They tested young
adults whose parents or grandparents had had type 2 diabetes. All were thin and
healthy, and none had diabetes at that point. But some were insulin resistant,
meaning that when they were given a test dose of glucose, it built up more than
it should have in their bloodstream. The researchers found out why: Inside their
muscle cells were tiny amounts of fat, fat that interfered with insulin’s ability to
work. Their bodies made insulin normally, and it reached their muscle cells with
no problem. Once it got there, though, it did not work properly. The muscle cells
simply could not fully respond to insulin because they contained bits of fat, like
gum jammed in a lock rendering a key useless.
How did this fat get there? Well, muscle cells normally store a tiny amount
of fat, which provides an energy source for physical activity. The amount is
normally quite small, and the fat simply waits for that day when you are much
more active than usual and need a bit of extra energy. For some reason, in these
young people, fat had built up much more than it should have—to levels 80
percent higher than in other young people. The fat buildup had reached the point
where it was gumming up the lock. That is, it was interfering with the cell’s
ability to respond to insulin, and that meant that diabetes was very likely in their
future unless something changed in a major way.
I should emphasize that the fat inside your cells is different from the fat
around your waistline. Even if you are quite slim, you may still be accumulating
fat within your muscle cells. The participants in the Yale study were slim,
averaging only 141 pounds. They were young and healthy. But just as young
people who smoke are setting the stage for cancer decades later, young people
who accumulate fat inside their muscle cells are paving the way for diabetes.
Until now, diabetes diets have not been designed to alter what goes on inside
the cells. Instead, they have been designed to compensate for the problem, so to
speak. Because your cells cannot handle glucose—that is, insulin has trouble
getting glucose into them—the diets limit sugars and foods that contain
carbohydrate, because when carbohydrate is digested, it releases sugars. But
what if a change in diet could actually alter the fat buildup within the cells and
reverse the trend toward gradually worsening insulin resistance?
I believe this is exactly what we can do—exactly what you will do as you
make the diet changes described in this book. But first, a few more details from
inside the cells.
Normally, insulin attaches to receptors on the cell’s surface and signals the cell membrane to
allow glucose to enter. However, if fat, called intramyocellular lipid, accumulates inside the cell, it
interferes with insulin’s intracellular signaling process. Tiny organelles, called mitochondria, are
supposed to burn fat, and their failure to keep up with the accumulating fat may be the origin of
type 2 diabetes. Luckily, evidence shows that diet changes can reduce the amount of fat inside
the cell.
TINY FURNACES THAT BURN FAT
There is a term for the tiny bits of fat that build up inside muscle cells. Scientists
call them intramyocellular lipids (intra- means “inside,” myo-is “muscle,” and
lipid is “fat”—literally, fat inside muscle cells). As you have seen, these traces of
fat start accumulating many years before diabetes manifests.
16
Let’s go one step further and look at how the fat builds up. Your cells have
microscopic “furnaces” or “burners” that are supposed to metabolize bits of fat
and convert it into energy. If all is operating normally, fat enters the cell and
these tiny burners use it up. These burners are called mitochondria, and they are
responsible for turning fat or other fuel sources into energy to power your
muscle cells. If you are steadily accumulating fat, that is a sign that your burners
—your mitochondria—are falling down on the job.
In type 2 diabetes, the problem appears to be too few mitochondria. That is,
people with type 2 diabetes have fewer mitochondria than they need to burn up
the accumulating fat. If they had more of these little “furnaces” inside each cell,
things would be very different.
Surprisingly enough, it may be that the number of mitochondria you have
depends on what you eat. Let me describe a second research study.
At Pennington Biomedical Research Center in Baton Rouge, Louisiana,
researchers studied 10 young men. They averaged just 23 years of age; were
reasonably trim, averaging 174 pounds; and were healthy. The researchers put
them on a high-fat diet that drew about half its calories from fats.
17
This is much
more fat than you would want to have in your diet, but it is not far different from
what many people actually eat. After just 3 days on a high-fat diet, the men had
accumulated significantly more intramyocellular lipids, so the first lesson of this
study was that fat builds up quickly. Depending on the foods you eat, you can
pack fat into your cells surprisingly rapidly.
Then the researchers tested the genes that produce mitochondria. Just as you
have genes in your cells that allow you to make bones, hormones, skin, hair, and
all the other structures of your body, you also have genes that serve as blueprints
for mitochondria. It turned out that the fatty foods these volunteers ate did more
than just pack fat into their cells; they actually turned off the genes that would
help burn fat. The genes that produce mitochondria were in fact partially
disabled. It was as if the men’s bodies were trying to avoid burning the fat they
had eaten so they could save it inside the cells for future use.
Imagine what this means: You have eaten fatty foods and, as a result, tiny
bits of fat have accumulated in your muscle cells. This fat interferes with the
normal workings of the cells, including their ability to respond to insulin. If
insulin is unable to work, glucose cannot get into the cells, and it builds up in the
bloodstream. Then, those fatty foods actually seem to disable your genes that
would produce the mitochondria you need to burn up this accumulating fat. Your
ability to eliminate fat inside your cells seems to be slowed down when you eat
fatty foods.
Let me speculate about why all this occurs.
Your body chemistry began to take shape many thousands of years ago, long
before fast-food restaurants and convenience stores ever got their first shipments
of cheese and fryer grease. Our human ancestors did not find fatty foods growing
on trees—or at least not many of them. On the rare occasions when they ate fatty
foods—meat, eggs, nuts, or avocados, for example—their bodies may actually
have tried to save some of the fat from these foods in case they needed it to
power their muscles or food became scarce. Thus, it would not be surprising if a
sudden influx of fat in the muscle cells signals them to turn off the fat-burning
mitochondria and save the fat for future needs. Today, of course, that is the last
thing we want. We want to power up our mitochondria—turn on those little
furnaces to eliminate fat.
Well, can you get rid of this fat? Let’s say you stopped eating fatty foods.
Would intramyocellular lipid start to disappear?
Let me share the results of a startling experiment. At Catholic University in
Rome, Italy, eight patients underwent gastric bypass surgery.
18
The operation is
commonly done as a last-ditch treatment for massive obesity, and for good
reason. What it involves is this: The stomach is stapled so that only a tiny pouch
about the size of an egg is left to receive food. Then the intestine is cut in two.
The first part of the intestine simply lies unused, while the lower portion of the
small intestine is attached directly to the tiny stomach pouch. In this way, the
patient cannot eat much food, and there is much less intestine available to absorb
the nutrients from whatever food is eaten.
After the procedure, the patients were essentially starving. They could eat
very little food at any given meal, and any fats they ate were poorly absorbed
because the first part of the small intestine, which is where fats are absorbed,
was no longer connected to the stomach.
As you might imagine, they lost weight, dropping from an average of more
than 300 pounds (137 kg) to 229 pounds (104 kg) in the first 6 months. That is
not unusual after such drastic surgery. What was striking was the effect on their
cells. The fat inside their muscle cells—their intramyocellular lipid—dropped by
87 percent. And even though they were still overweight, their insulin resistance
had largely disappeared.
I am not recommending that you have this procedure. I am presenting these
findings to make a critically important point: The fat inside your cells is not a
permanent fixture. If the influx of fat stops, the fat inside the cells dissipates, and
when that happens, the cells start to regain their normal function.
Surgery is a drastic solution, but the Italian researchers also tested whether a
low-calorie diet without surgery could deplete intramyocellular lipid—and it did.
Following a 1,200-calorie diet for 6 months, the patients lost about 30 pounds on
average and eliminated about 8 percent of the fat inside their cells. Now, that
modest result came from a diet that focused just on cutting calories rather than
on eating particular types of food, which will be the focus of this program. The
next step is to make the diet more powerful so it works a little more like surgery,
without all the obvious risks of an operation.
Let’s go a step further. At Imperial College School of Medicine in London,
researchers studied a group of individuals following a vegan diet. They
compared the participants to others who were similar in age and body weight but
were not following a vegan diet.
19
When the researchers measured the
intramyocellular lipid in each participant’s calf muscles, they found it was 31
percent lower in the vegans than in the omnivores. It looks as if there is
something about the diet that helps prevent fat buildup in cells.
These studies show—loudly and clearly—that the accumulation of fat in the
cells and all the problems it causes are not simply a matter of genes. Genes do
play a role, but these effects are very much a matter of diet, too, and it can
change dramatically.
In Part 2, you will see how to select foods to address this problem in the
most powerful way possible.
*
The study turned up another particularly remarkable finding. In a laboratory at george Washington
University, we measured the participants’ metabolism—how fast their bodies burned calories. This was
done by measuring how much oxygen they consumed minute by minute and how much carbon dioxide they
produced after being given a test meal (two cans of a standard liquid formula).
After 14 weeks on the experimental diet, it was clear that the participants had a significant increase in
their after-meal calorie burn; their after-meal calorie-burning speed increased by 16 percent.
9
CHAPTER 3
A Revolution in Type 1 Diabetes
If you have type 1 diabetes, the diet changes you will soon learn about can be
lifesaving. No doubt you have heard that type 1 diabetes increases the risk of
heart problems and other complications. When you really take control, however,
all these risks plummet.
Research has proven that you are not powerless against the complications of
diabetes. There is a lot you can do to protect yourself.
The Diabetes Control and Complications Trial did it with medication. The
study was sponsored by the US government and included 1,441 people with type
1 diabetes. Some of the participants took insulin once or twice daily, as is
common practice. The remaining participants were asked to follow a more
intensive program. They took insulin three or four times daily, either by injection
or via an insulin pump. They checked their blood glucose several times a day
and adjusted their insulin doses accordingly. Over 17 years of follow-up, the
extra care these individuals took paid off dramatically. Careful tracking of blood
sugar and medication adjustments lowered the risk of heart problems by 50
percent.
1
Also, although people with diabetes are at risk for eye problems, careful
blood glucose control reduced that risk by 76 percent compared to people on
traditional medical therapy. It cut the risk of kidney problems by 39 percent and
reduced the risk of neuropathy by 60 percent.
2
The study treatment involved medication rather than diet, but it proved a
vitally important point. Many people had imagined that diabetes complications
are simply inevitable; this study showed otherwise. Gaining control over your
blood glucose makes an enormous difference. Now, with type 1 diabetes, you
will need to use insulin to achieve that goal. But diet and exercise offer
additional power that too few people take advantage of. And diet is the focus of
this book.
Also, it is important to understand that blood sugar control—as vital as it is
—is just one part of the equation. Your risk of developing problems with your
heart, kidneys, eyes, or extremities also depends on your blood pressure,
cholesterol levels, and other factors. The goal now is to adjust your diet to
control all of these to the extent that we can, adding medications as necessary
according to your doctors advice.
TOWARD AN OPTIMAL LIFESTYLE
In type 1 diabetes, your greatest risk is to your heart and blood vessels. If you do
nothing, cardiovascular disease lies in wait. In fact, it strikes the majority of
people with type 1 diabetes. We now have a better understanding than ever
before about how to use diet and lifestyle changes to protect the heart, not only
for people with diabetes but for anyone. Chapters 4 and 5 will cover how and
what to eat in great detail, and Chapters 12 and 13 will discuss the complications
head-on. In the meantime, here are the keys.
A healthy diet. Follow the diet steps outlined in the next chapter. These
practices eliminate cholesterol and animal fat, keep fats in general very low, and
guide you away from sugar and refined carbohydrates and toward healthy
complex carbohydrates.
As you will see, there is a special advantage to a vegetarian diet, or I should
say a vegan diet—meaning a menu that includes no animal products at all.
Dietary cholesterol is found only in animal products.
*
Animal products also tend to be high in the saturated (“bad”) fats that tend to
cause your body to make additional cholesterol, an effect that is actually much
greater than eating cholesterol itself. A plant-based diet eliminates these
problems. It has another major benefit as well: It derives its protein from plants
rather than from animal products. Research studies have shown that among
people with any degree of kidney damage, animal protein increases the risk of
further kidney deterioration.
3
On the other hand, healthy beans, grains, and
vegetables are just what your kidneys ordered.
A plant-based diet does more than reduce your risk of complications. It may
also reduce the amount of insulin you need. When people with type 1 diabetes
begin a low-fat, vegan diet, many report that their insulin requirements fall
dramatically. Although the reasons for this are not entirely clear, it is a very
welcome result.
Please read the next chapters very carefully. They will show you how to
begin.
No smoking. If you smoke, now is the time to stop. If you have tried 50
times, it is time for try number 51. You can and will succeed. Ask your doctor to
help you.
Regular exercise. Even modest exercise, such as daily walking, makes a big
difference. See your doctor, who will assess your heart, your joints, and your
overall health to make sure you are ready for exercise. See Chapter 11 for ways
to get started.
Stress management. Stress affects your health directly, causing fight-or-
flight hormones to flood into your bloodstream. In turn, these hormones
typically raise your blood sugar. Stress also disrupts your eating routines and
interferes with sleep.
Getting a handle on stress does not mean stepping back from the challenges
of life. It means finding ways to enjoy life fully without letting stress get out of
control. There are many healthy ways to relax, including meditation, yoga, and
even simple breathing exercises.
As you saw in the previous chapter, Dr. Dean Ornish showed that these four
steps—a healthy vegetarian diet, smoking cessation, regular exercise, and stress
management—can actually reverse heart disease, even without the use of
cholesterol-lowering medications. That is a tremendous benefit. Your doctor may
add medications to your regimen to protect you further.
These lifestyle changes will not eliminate the need to use insulin for type 1
diabetes. But they can help you stay healthy, minimizing the effects of diabetes
on your life.
A NEW UNDERSTANDING OF THE CAUSES OF TYPE 1 DIABETES
Let’s think for a moment beyond improving the health of people with type 1
diabetes. What if we could actually prevent it in the first place? Research over
the past 3 decades suggests that we may already have the ability to prevent many
cases of type 1 diabetes.
If you thought the disease was simply genetic and there was no way to stop
it, read on. Studies of identical twins have set that notion aside. Identical twins,
of course, have exactly the same genes, so they have the same hair color, eye
color, and facial features. If a disease were simply genetic, then both twins
would have it. But type 1 diabetes does not work that way. As I mentioned in
Chapter 1, if one twin has diabetes, the other has less than a 40 percent chance of
developing it.
So, although genes play a role, it is clear that type 1 diabetes is not simply a
genetic disease. Something else triggers it—something in the child’s early
environment.
For many years, researchers have known that type 1 diabetes occurs when
the immune system attacks and destroys the insulin-producing cells in the
pancreas. Your immune system, of course, is your defense against viruses,
bacteria, and cancer cells. It is not supposed to attack your own healthy body
tissues, but that is exactly what occurs in type 1 diabetes.
To understand why this happens, let’s look at a few basics. The complex
defense network of your immune system is made up of specialized white blood
cells. Some of these cells engulf invading germs and digest them. Others make
antibodies—molecules that attach to invading organisms like harpoons and
identify them for other immune cells to attack. If you have type 1 diabetes, your
immune system has made a major error: It has attacked and destroyed your
insulin-producing cells, resulting in what scientists call an autoimmune disease.
But why does it occur? Back in 1992, a team of Canadian and Finnish
researchers reported an important discovery in the New England Journal of
Medicine. Examining blood samples from 142 children newly diagnosed with
type 1 diabetes, they found that each of the children had antibodies that were
primed to attack cow’s milk proteins. These antibodies had apparently arisen in
response to cow proteins in their infant formula, but the antibodies were also
capable of attacking the body’s insulin-producing cells.
4
It turned out that a
portion of the cow’s milk protein was biochemically an exact match for a portion
of human insulin-producing cells. The antibodies that arose to destroy the cow’s
milk protein ended up attacking the children’s insulin-producing cells. The
pancreatic cells were destroyed by “friendly fire.”
This study and others suggested a scenario that could lead to type 1 diabetes.
It has long been known that when a very young infant is fed cow’s milk formula,
some of the milk proteins pass from the digestive tract into the bloodstream.
5, 6
It
is possible that the infant’s immune system recognizes these bovine proteins as
foreign and forms antibodies to attack them and that these antibodies attack not
only the cow proteins but also the insulin-producing cells of the pancreas. This
destructive process is presumably gradual; when nearly all the insulin-producing
cells are gone, type 1 diabetes results. The researchers believed that the mature
digestive tracts of adults would not allow these dairy proteins to pass through the
intestinal wall and into the bloodstream, but in infants, the molecules passed
through more easily.
The study suggested that one way to prevent type 1 diabetes, at least for
many children, might be to avoid exposure to cow’s milk early in life. Needless
to say, in the early 1990s, neither parents nor pediatricians had any idea about
this. Cow’s milk formulas were routinely fed to infants, and they still are. When
children are not breastfed, some sort of formula has to be used. And while some
children are given soy formulas that would presumably pose no diabetes risk,
many are given cow’s milk varieties.
In 1992, when the New England Journal of Medicine report emerged, the
well-known baby doctor Benjamin Spock, MD, and I held a press conference.
We were joined by Frank Oski, MD, director of pediatrics at Johns Hopkins
University, and other nutrition experts. We recommended that parents be given
information about the potential risks of early exposure to cow’s milk. After all,
parents are pushed very hard to give cow’s milk to their children, but they rarely
hear of potential risks it might pose. We called for an end to recommendations
that push milk consumption on children and said that parents should have good
information in order to decide what to feed their children.
The event proved controversial. Most major newspapers and broadcast
channels covered the story. The American Medical Association (AMA) sharply
criticized Dr. Spock and me for casting doubt on the healthfulness of dairy
products. Research teams trying to replicate these findings got mixed results,
with some coming up empty-handed. Still other researchers pointed out that
finding the antibodies required special techniques, without which the antibodies
would remain elusive.
7
Eventually, the American Academy of Pediatrics
convened a work group to look into the matter. Two years later, in 1994, the
group issued a report. Based on more than 90 studies, the group agreed that
indeed, the risk of diabetes can very likely be reduced if infants are not exposed
to cow’s milk proteins early in life.
8
Eventually, the AMA withdrew its
objections.
While Dr. Spock and I felt there was already substantial evidence and good
reason to issue cautions about exposure to dairy products early in life, the
controversy did not end there. There was only one way to know whether dairy
proteins could actually incite the series of events leading to type 1 diabetes: The
theory had to be put to the test. A european team began that process.
TESTING THE DAIRY-DIABETES THEORY
In a pilot study, researchers in Finland, Sweden, and Estonia identified 242
newborns at risk for developing type 1 diabetes—each had a first-degree relative
with the condition. The researchers then encouraged their mothers to breastfeed.
When mothers were ready to wean their infants, the researchers asked half to use
a specially modified baby formula in which dairy proteins were broken up into
individual amino acids—protein building blocks that are too small to elicit an
immune reaction. The other families were allowed to use a regular cow’s milk
formula. The research aimed to see whether avoiding exposure to intact cow’s
milk proteins could reduce the likelihood of developing diabetes.
9
As the years went by, the researchers found that the children who were fed
the special formula were much less likely to develop the dangerous antibodies.
In fact, the risk of developing antibodies to their insulin-producing cells was cut
by 62 percent.
The study was small, only a pilot trial, but it did follow most of the children
through their first 6 to 8 years of life. During those years, several children
developed diabetes. Of those receiving unmodified formula, eight developed the
disease, and in the modified-formula group, five developed it. As it turned out,
two of those five had dropped out of the study right at the start and never
actually received the modified formula. That meant that only three children in
the modified-formula group developed diabetes, compared to eight in the
regular-formula group. The study suggested that the cow’s milk theory may well
be part of the puzzle, but it was too small to be definitive, and the research team
began a much larger test in 2002 involving families in 15 countries.
There were some limitations to this pilot study. First, it restricted dairy
consumption only during the first several months of life. It is not clear whether
later exposure, say, at 8 or 9 months of age, might put some children at risk as
well. After all, it has long been known that very large dairy protein molecules
can sometimes pass from the digestive tract into the bloodstream, even in adults.
The study did not address whether exposure to dairy proteins could trigger type
1 diabetes in children who are beyond early infancy.
Second, the study did not ask breastfeeding mothers to avoid cow’s milk in
their own diets. For decades, we have known that some cow’s milk proteins
ingested by a nursing mother end up in her breast milk. They come from her
digestive tract, are absorbed into her bloodstream, and find their way into the
breast milk, sometimes making babies colicky.
10
Thus, in order to avoid
exposing babies to dairy proteins, it is important to eliminate them not only from
infants’ diets but also from the diets of their breastfeeding mothers.
One last caution about this study: It did not actually exclude dairy products
from the children’s diets. Rather, it used a milk product treated to break up the
dairy proteins. If anything in milk other than these proteins contributes to the
problem, this study would not have been able to detect it. Even so, it was an
important step in coming to understand how parts of an infant’s diet may lead to
diabetes.
The study illuminated other contributors to diabetes, too. Prior evidence had
suggested that viral infections may play a role, and indeed, viruses appear to
have done so for some infants in the milk study. Specifically, viruses seem to
stimulate immune cells, perhaps making them more active against cow’s milk
proteins than they would normally be. Or, cow’s milk proteins may influence the
course of viral infections in some way.
11
The idea is that the interplay between
cow’s milk formula and viruses may put babies at increased risk.
No one knows what the research on milk and type 1 diabetes will ultimately
show. If the theory turns out to be correct, it suggests that avoiding cow’s milk
products, at least during the first several months of life, could greatly reduce the
likelihood of developing this disease.
Needless to say, breastfeeding instead of feeding formula poses no risks for
children. Quite the opposite: Breastfed babies gain many advantages, including
better overall health and even a few extra IQ points, compared to their formula-
fed counterparts. And the most healthful breastfeeding is done when mothers
follow a diet free of foods that can harm their babies.
Other risk factors for diabetes may yet emerge in research studies. And for
children who are already in the midst of an antibody attack, researchers are
studying means of intervening to try to stop the destruction of their insulin-
producing cells.
STAYING HEALTHY
If we are able to prevent diabetes, we will have a very powerful tool at our
disposal. For people who already have type 1 diabetes, there are effective steps
they can take to help them stay healthy. Keeping blood glucose under control is
essential, and stabilizing cholesterol levels and blood pressure protects the heart
and blood vessels. The same sort of diet that is described in this book for type 2
diabetes is likely to be enormously beneficial for people with type 1 as well,
helping them to prevent complications and reduce their insulin doses.
*
It is a good idea to eliminate cholesterol from your diet completely. There is no “good” cholesterol in
foods. Rather, cholesterol in foods always tends to increase your blood cholesterol level. This is in contrast
to cholesterol that is measured by blood tests, which doctors separate into “good” (HDL) cholesterol and
“bad” (LDL) cholesterol, among other forms. HDL cholesterol is “good” because it is leaving the body.
PART 2
The Program
CHAPTER 4
A Powerful New Menu
We are setting our sights on a dramatically better result than previous diets could
deliver—a result that’s possible through a new approach to eating that I will
explain in this chapter. If you have type 2 diabetes, you do not want to cater to
insulin resistance; you want to counteract it. If you have type 1 diabetes, you
want to get your blood sugar under good control, minimize your medications,
and stay in good health. This chapter will show you the principles of
revolutionizing your menu. Then, in the following chapters, I will show you how
to put them to work as you plan your meals.
For type 2 diabetes, our goal is to “clean the gum out of the locks.” As you
recall, the fundamental problem in type 2 diabetes appears to be the
accumulation of tiny amounts of fat inside muscle cells. They make it hard for
insulin to do its job by blocking what is called insulin signaling. That is, they
interfere with the process by which insulin opens the cell membrane to allow
glucose to enter. You need to select foods that reverse this process.
A diet revamp can also help protect your body from the disease process. That
is crucial for both type 1 and type 2 diabetes.
As you will see, these diet changes are far-reaching and powerful. You may
also find, as many of our study participants did, that learning the plan’s
guidelines is a simple process. There are no limits on portions, calories, or
carbohydrates. You will focus on what you eat, so how much you eat generally
takes care of itself. But we are getting ahead of ourselves.
Let’s first look at the menu changes that make the diet so effective. Then, in
the following chapter, I will walk you through various ways to adopt them to
make this diet doable for you.
To reverse the course of diabetes, “clean the gum out of the locks,” and allow
the heart and blood vessels the best chance of reversing any existing blockages,
there are three guidelines.
1. Set aside animal products.
2. Keep vegetable oils to a minimum.
3. Favor foods with a low Glycemic Index.
Now, there is no need to panic. I know this sounds like a tall order. I am
going to walk you through each step to show you the whys and hows. Soon, it
will be second nature. For now, I just want you to understand the principles.
1. SET ASIDE ANIMAL PRODUCTS
There are two possible sources of fat in the diet: animal products and vegetable
oils. This guideline tackles the first of these.
Needless to say, if you are not eating beef, you will not get any beef fat. If
you are not eating chicken, you will not get any chicken fat. Following this
guideline means purging the animal fat from your diet. The program you are
about to start omits meat, dairy products, and eggs.
As you saw in Chapter 2, researchers who measured the fat inside the muscle
cells of people on high-fat diets showed that the fat you eat can rapidly increase
the amount of fat in your cells. Exactly the opposite appears to happen in people
who avoid animal products. As you recall, people following a vegan diet had 31
percent less intracellular fat compared with people on a regular diet.
1
That means
improved insulin sensitivity. That is a great start, and the next guidelines are
designed to carry you further.
You will get another benefit. When you set aside animal products, you do
more than free yourself from animal fat; since animal products are the only
source of cholesterol in the diet, leaving them off your plate also eliminates all
the cholesterol from your diet. As your cells reclaim their health, the rest of your
body does, too.
Instead of eggs and bacon for breakfast, you might have a big bowl of old-
fashioned oatmeal with cinnamon or blueberries, half a cantaloupe, and some rye
toast. Perhaps you might add some veggie sausage or veggie bacon.
For lunch, instead of, say, meat chili, you might have veggie chili or hearty
lentil soup. If you generally go for a burger, you might choose a veggie burger. If
you have dinner at an Italian restaurant, you might have spaghetti with tomato
sauce, wild mushrooms, artichoke hearts, and fresh basil. At a Mexican
restaurant, you would skip the meat taco in favor of a bean burrito (hold the
cheese) or veggie fajitas. At a Chinese restaurant, you could have your pick of
the many vegetable dishes on a bed of rice.
At this point, you may be thinking, “Spaghetti? Rice? Am I allowed to have
these carbohydrate-rich foods?” The answer is yes. Now, I know that people
with diabetes have heard over and over that they must limit rice, pasta, and other
starchy foods. But keep in mind that diabetes—and overweight—has been rare
in countries that have made these foods their staples. The plan does have
guidelines about carbohydrates, but they relate mainly to which ones are the best
choices, not how much you put on your plate. In our studies, we have found that
people who include plenty of healthy carbohydrates in their diets do better, not
worse.
“I can understand omitting beef,” you may say, “but why eliminate chicken
and fish?” Well, the nutritional makeup of these foods may surprise you. They
have significant amounts of fat and cholesterol, and they lack the fiber and
healthy carbohydrate you need.
Chicken, of course, is where chicken fat comes from. Even if you strip away
the skin and eat only white meat, about 23 percent of the calories come from fat.
Much of that fat is the “bad” form—saturated fat, the kind that pushes your
cholesterol upward and worsens insulin resistance.
Fish vary. Some types are lower in fat than chicken, while others, such as
salmon, are quite high. But all fish have fat, and much of it—between 15 and 30
percent—is saturated fat. All fish have cholesterol, too. Some, such as shrimp
and lobster, are much higher in cholesterol, ounce for ounce, than steak.
Of course, some people eat fish precisely because it has fat in it. That is, a
portion of the fat in fish is in the omega-3 form. Omega-3 fats are reputed to
block the formation of blood clots that could lead to heart attacks.
Scientific evidence has not been supportive. In large, carefully conducted
research studies, fish oils have not been shown to protect the heart. They do not
reduce the likelihood of a heart attack or stroke or reduce the risk of dying. They
do not help healthy people who are trying to avert their first heart attack, and
they do not work for people who have already had a heart attack and are trying
to avoid another one.
2, 3
Could the supposed benefits of omega-3s be just a fish story? Well, it is
important to remember that fish fats are mixtures, just as all fats are. Fish oils do
indeed contain some omega-3 fat, but they also contain plenty of saturated fat.
As noted above, from 15 to 30 percent of the fat in fish is plain old saturated fat.
That’s less than in beef (about 50 percent) or chicken (about 30 percent), but it is
considerably more than you need. There is no specific need for saturated fat in
your diet at all.
The load of fat in fish might explain the disconcerting fact that fish
consumption is linked to a higher risk of developing diabetes. In 2009, the
American Diabetes Association reported in its journal, Diabetes Care, that
people who regularly ate fish, but no other meats, had a 4.8 percent prevalence
of diabetes, compared to 3.2 percent for lactoovo-vegetarians and 2.9 percent for
vegans.
4
In other words, having fish in your diet does not help; it actually
increases diabetes risk.
Similarly, Harvard researchers found that people who ate the most fish had a
24 percent higher risk of developing diabetes, compared with those who
generally avoided fish.
5
Finally, if you are looking to lose weight, it is important to note that “good
fats” pack in just as many calories as “bad fats.” That is to say, omega-3s are
every bit as fattening as any other fat or oil. All fats and oils have 9 calories in
every gram, compared with only 4 calories per gram of carbohydrate.
In practice, chicken-and-fish diets are routinely disappointing. We have
carefully tested these diets and found that, even when they are followed very
closely, their ability to reduce LDL (“bad”) cholesterol is only about half that of
a plant-based (vegan) diet, and their ability to control blood sugar or blood
pressure or to help you lose weight is limited, too.
6
Much more effective are diets that eliminate animal products altogether. Our
studies and those of other researchers have shown that plant-based diets cut LDL
cholesterol far more effectively than any other diet approach.
Now, you will notice that when you avoid animal products, your diet is not
just free of animal fat; it is also free of animal protein. That is important because
animal protein can harm the kidneys, and protecting them is a key goal. Protein
from plant sources is the way to go.
If life without chicken or cheese sounds challenging, take heart from the
experiences of the folks who participated in our research. They found the
transition to be smooth. They found tastes they liked better than their old go-to
foods. And within a few weeks, they were very much in charge—not only of
their menus but also of their health. They found that excess weight was already
starting to melt away, their blood sugar was coming under control, their
cholesterol levels were falling, and very soon, many started to cut back on—or
even discontinue—their medications.
What a Difference: Animal versus Plant Foods
FAT (% OF CALORIES) CHOLESTEROL (MG)
Salmon, Atlantic
40
71
Beef, bottom round, lean* 33 86
Chicken, white meat, skinless 23 85
Pork loin, lean 41 81
Trout, rainbow 35 69
Tuna, white 21 42
Apple 3 0
Beans, navy 4 0
Broccoli 11 0
Lentils 3 0
Orange 4 0
Rice, brown 7 0
*Meat servings are 3.5 ounces (100 grams).
SOURCE: USDA, Agricultural Research Service Nutrient Data Laboratory,
https://ndb.nal.usda.gov/ndb/search/list, accessed April 8, 2017.
Ready for a Change
In one of our research studies, half the volunteers were assigned to a low-fat vegan diet, and
the other half were instructed to follow a more conventional diet for diabetes. Since it was to be
an unbiased test, the diet assignment was done by a computer. So the process was random,
and neither the volunteers nor we had any influence over who got which diet. Nonetheless, I
was curious about how the volunteers felt about the two diets, so I asked them. If there had
been an opportunity to choose one of the diets, which one would they have chosen? I expected
most to say they would have chosen the conventional diet—it is familiar to most people who
have been diagnosed with diabetes, and I thought the volunteers might feel a bit of trepidation
about giving up meat and dairy products.
As it turned out, their preferences were just the opposite. The volunteers actually preferred
the vegan diet by about two to one. The reason, I learned, was that many had already been on
a conventional diet and had found it dull and not very effective. Many of them had heard about
the advantages of a vegan diet. Others had relatives who followed a vegetarian or vegan diet,
and they wanted to give it a try.
Both groups embraced their assignments. Some did well on the conventional diet and some
did not. The results with the vegan diet, however, were powerful and consistent.
How Nancy and Vance Did It
How did Nancy and Vance, whom you met in the Introduction, fare with the diet
changes?
For Nancy, the change was a welcome one. She was fed up with the lack of
results from the previous diet she had been given and thought a vegan diet
sounded like a good approach. She wanted to lose weight, and she was sick of
feeling so low on energy. This, she hoped, might be an answer.
Nancy grew up in Minnesota. Her mother was not an especially talented
cook, she says, but her Scandinavian family loved food. Her mother and sisters
all struggled with weight problems.
Like most of our study volunteers, Nancy had already made healthy changes
to her diet over the years. She had stopped eating beef, ate plenty of vegetables,
and had gotten away from fatty dressings, so making the shift was reasonably
easy.
As she began the study, she started her day with oatmeal topped with
cinnamon and fat-free vanilla soy milk. At midmorning, she liked to have a
snack, usually fruit such as apples, bananas, raspberries, blueberries, grapes, or
oranges.
For lunch, she had a hearty vegan soup such as minestrone, vegetable soup,
sweet potato soup, or chili, along with a salad made with fresh spinach;
tomatoes; red, yellow, and orange bell peppers; kidney beans and chickpeas; and
other ingredients. Her afternoon snack was often fruit, rye crackers, baked
tortilla chips with salsa, or hummus and pita bread.
After a long day at work, Nancy had no interest in preparing a gourmet meal,
so her dinners were quick and easy: a veggie burger with frozen mixed
vegetables, which she microwaved. Sometimes she had nothing more than a
bowl of bran cereal. A late-night fruit snack rounded things out.
We gave her group a supermarket tour and provided cooking demonstrations
to introduce everyone to healthful products that might be new to them. Nancy
preferred to keep it simple and started making a large pot of soup to eat all week.
“I am not a cook,” she said. “And I find it very easy to stay on this program.”
Vance usually started his day with oatmeal, either plain or with apples and
cinnamon. He also had toast and fresh fruit. Lunch or dinner was pasta or
burritos along with fresh vegetables and fruits. Sometimes his taste called for
salads, usually dressed up with beans, blood oranges, or other additions.
“I had to learn to read labels,” he said. “It is easy to underestimate the
amount of fat or sugar in a can of food. A label might show 6 grams of fat, and
you might think that means the whole can. But it actually means just one
serving.”
For Vance, the vegan diet was the way to go. “I don’t have the personality
that would let me have just a small piece of chicken or a small piece of beef,” he
explained. “I have to cut it out altogether. For me, this is a lifestyle change.”
THE POWER PLATE
For starters, let me introduce you to the Power Plate, a simple meal-planning
guide that my colleagues and I developed. The idea is simple: Build your diet
from four healthy staples—whole grains, legumes, vegetables, and fruits.
On your plate, these simple ingredients might translate into a hearty sweet
potato chowder, spinach lasagna, Cuban black beans and Spanish rice, lentil and
carrot soup, and endless other possibilities. But let’s first take a look at the staple
foods themselves. These are the ingredients that build healthful meals.
The whole grain group. This group includes brown rice, oats, barley, corn,
and all the products that are made from whole grains: breads, cereals, pasta, and
many others. In countries where grains are staples, diabetes is much less
common than it is in North America and europe. This should be no surprise:
Whole grains are filling but have very little fat and no cholesterol. When
selecting grains, let the Glycemic Index guide you to the best choices.
The legume group. This category includes beans, peas, and lentils. It also
includes the endless array of soy products, from veggie burgers to meatless hot
dogs, tofu, tempeh, miso, and every conceivable kind of deli slice. Legumes are
hearty, high-protein foods with a remarkably low GI. They are rich in calcium,
iron, and cholesterol-lowering soluble fiber. Whether you favor a chickpea salad,
black bean chili, or a soy-based veggie burger or other meat substitute, legumes
are handy and healthy.
The one thing the bean group lacks is good public relations. Its health
benefits have gone largely unnoticed. Nutrition scientists, however, know that
putting these healthy powerhouses front and center on your menu is a great way
to drive down your weight, blood sugar, and cholesterol. The US government’s
National Nutrition and Health Examination Survey showed that people who
included beans in their regular menu weighed, on average, 6.5 pounds less than
people who generally neglected this healthy food group.
7
The trend showed up
in teenagers, too. Teenage bean lovers weighed 7 pounds less and had waistlines
that were nearly an inch slimmer compared with their bean-avoiding peers.
8
Researchers at the University of Toronto confirmed that people who include
a serving of beans, chickpeas, lentils, or peas in their daily routine are indeed
thinner and have lower levels of LDL (“bad”) cholesterol.
9, 10
If you are new to bean dishes, go easy at first, keep portions modest, and
cook them thoroughly. They are likely to cause some gassiness until your
digestive tract adapts.
The vegetable group. Each member of the vegetable group is robustly
healthful. The green vegetables—asparagus, broccoli, spinach, kale, Swiss
chard, and many others—are packed with iron and, except for spinach, high in
absorbable calcium. Orange vegetables—carrots, yams, and butternut squash,
among others—are loaded with beta-carotene, a cancer fighter. Be generous with
them.
Instead of the neglected little pile of overcooked vegetables some people
park on their plates, have two or even three different vegetables with your
dinner. One of my favorite combinations is “orange plus green,” as in mashed
butternut squash and broccoli. Sometimes I cook them up fresh, and other times,
I simply use frozen. The colors contrast, as does the sweetness of the squash
with the heartier flavor of broccoli. You do not have to be a gourmet chef. Even
the most hurried person has time to open a package of frozen vegetables and
steam or microwave them.
These foods are loaded with vitamins and minerals, are very low in fat, and
like all plant foods, have no cholesterol at all.
Virtually all have healthy low GIs. The main exception is baking potatoes, so
favor sweet potatoes instead.
The fruit group. Fruits are loaded with vitamins and, of course, have
essentially no fat or cholesterol. Many people with diabetes imagine that because
fruits are sweet, they will raise blood sugar. The fact is, though, that nearly all
fruits—apples, bananas, blueberries, cherries, clementines, oranges, peaches,
pears, and most others—have low GIs.
For a simple and beautiful dessert, combine blueberries with chopped
mango, papaya, or banana. You’ll think of many other great combinations.
How many servings should you have from each group? You can vary your
serving sizes as much as you like. If you prefer Mediterranean cuisine, your
plate may be rich in vegetables and pasta. If Asian food is your thing, your plate
may hold generous portions of rice or other grains. If you love Latin American
foods, you might go for bean dishes. If you come from a typical North American
background, you will probably want a variety of all four. In the next chapter, I
will show you some easy, delicious ways to get started.
It goes without saying that the recommended foods do not include meat,
dairy products, eggs, or greasy fried foods.
Grapefruit interacts with medications
Surprising as it sounds, if you are on certain medications, you may need to avoid grapefruit.
11
A serving of grapefruit or a glass of grapefruit juice can measurably increase the blood
concentrations of drugs you may be taking, to the point of toxicity. Here’s how it works: Let’s
say you were to swallow a cholesterol-lowering drug, like atorvastatin (Lipitor). Normally,
enzymes in your intestinal tract and liver will inactivate some of it, reducing the amount that is
actively circulating in your blood. This is entirely normal, and your dose was determined with
that in mind.
But grapefruit knocks out these drug-limiting enzymes. As a result, you end up with more of
the active drug in your bloodstream. About half of all oral medications are metabolized by these
enzymes, and even one serving of grapefruit has an effect that lasts all day.
For cholesterol-lowering drugs, this is an issue for atorvastatin (Lipitor), simvastatin (Zocor),
and lovastatin (Mevacor), but not for pravastatin (Pravachol), rosuvastatin (Crestor), or
fluvastatin (Lescol), because they are metabolized differently.
Grapefruit does the same for dozens of other drugs. So if you have a taste for grapefruit,
check with your doctor about how it might interact with any medications you are taking. The
same effect comes from limes, Seville oranges (used to make marmalade), and pomelos, but
not from typical navel or Valencia oranges. The problem occurs only with oral medications, not
injectables.
Other Permitted Foods
Fat-free salad dressings and other fat-free condiments
Coffee (with fat-free nondairy creamer, if desired)
Occasionally, alcoholic beverages
Rarely, sugar, nuts, seeds, dark chocolate (made without milk), full-fat soy
products such as tofu, tempeh, soy cheese, etc.
Foods to Avoid
Meats, poultry, fish, eggs (whites and yolks), and all dairy products (regular
and fat-free), including milk, yogurt, cheese, ice cream, cream, sour cream,
butter, etc.
Added oils, such as margarine, salad dressings, mayonnaise, cooking oils,
etc.
Fried foods, such as potato chips, french fries, onion rings, doughnuts, etc.
Avocados, olives, and peanut butter
Foods with high GIs, such as white bread or white potatoes
Vitamin B
12
and Vitamin D
Although foods will give you most of the nutrition you need, two supplements
are important: vitamin B
12
and vitamin D. Vitamin B
12
is essential for healthy
nerves and healthy blood, and vitamin D is important for your bones and may
reduce cancer risk. All typical multivitamins contain both and are very
convenient. But because multivitamins also have ingredients you may not want
(e.g., iron and copper), you can instead just pick up these two vitamins at any
drugstore or health food store. You’ll find more details in Chapter 10.
Soup Nirvana
Walter arrived at one of our research meetings to announce that he had found the perfect
lunch. His local supermarket stocks a line of soups from the Tabatchnick company that happen
to come in several low-fat vegan varieties, such as black bean soup, split pea soup, and
vegetarian chili. With simple, natural ingredients, a serving has about 200 calories and just a
gram or two of fat. They are available in both regular and low-sodium versions. Since they are
frozen, they keep more or less indefinitely and can be microwaved to make a meal in minutes.
There are also many other great brands, including Dr. McDougall’s, Health Valley, and
Amy’s, that are easy, quick, and healthful.
Healthier Substitutes for Dairy Products
It may surprise you to learn that some of the biggest sources of fat are lurking in
the dairy section. Milk, cheese, and ice cream once enjoyed a healthful
reputation that few people questioned, but that has changed. It has become clear
that these foods are actually the largest source of saturated (“bad”) fat in the diet,
and also contribute cholesterol, animal protein, and, in the case of fat-free
varieties, a big load of lactose sugar.
Here’s the lowdown on dairy, followed by the good news about how easy it
is to replace it.
Dairy fat. Cow’s milk derives, believe it or not, 49 percent of its calories
from fat. That is a lot by any standard. You may imagine that 2 percent milk is
much lower in fat. Not so. That 2 percent figure refers to fat content by weight,
which is deceptive because it is thrown off by milk’s water content. When you
drink a glass of milk, your body absorbs that water. What matters for your health
is how much fat you are left with. Nutritionists look for the percentage of
calories that come from fat because that figure is unaffected by water content. It
turns out that for 2 percent milk, about 35 percent of calories come from nothing
but fat.
What is particularly worrisome about milk, though, is the type of fat it
contains. Most of it is saturated fat, the very kind that is linked to insulin
resistance and raises cholesterol levels. Dairy products are actually the leading
source of saturated fat in the diet.
Typical yogurt, ice cream, and sour cream products are high in fat, too.
Cheese is loaded with it. Many brands derive about 70 percent of their calories
from fat.
Dairy sugar. Fat-free dairy products have had their fat removed, but what’s
still there may surprise you. When the fat is skimmed away, the predominant
nutrient in milk is actually sugar—lactose, the dairy sugar.
The lactose molecule is a combination of two smaller sugars, glucose and
galactose. Approximately 55 percent of the calories in fat-free milk come from
lactose. People who quite rightly avoid sodas and other sugary drinks because of
their sugar content will want to be aware that milk products are a major source
of sugar, too.
Lactose, of course, is the sugar that causes digestive upset for many people.
Lactose intolerance is a normal condition that occurs when the enzymes that
allow babies to digest mothers milk naturally start to dissipate. When these
enzymes are gone, lactose passes through the intestinal tract undigested. In the
lower intestinal tract, bacteria start to ferment the sugar, causing gas, cramps,
and diarrhea. Lactose intolerance was once thought to be an abnormality but is
now known to be the biological norm. The symptoms come on gradually,
sometime after early childhood, and they are simply a sign that you have
successfully passed the age of weaning.
Dairy proteins. These proteins have come under scrutiny for their potential
contribution to type 1 diabetes, as described in Chapter 3, but they are implicated
in many other health concerns as well. Animal proteins appear to accelerate the
gradual loss of kidney function that can occur in diabetes.
12
Plant sources of
protein—beans, grains, vegetables, and soy products, for example—do not
appear to cause this problem.
People who have migraines often report improvement when they avoid
certain foods, and milk and other dairy products are often at the top of the list.
The same has been reported for some cases of rheumatoid arthritis. The problem,
it appears, is not the fat or lactose, at least not for these conditions. The trigger
seems to be the dairy proteins.
Dairy products are linked to other health problems ranging from acne to
prostate and ovarian cancer. It is the latter issue—cancer—that has gotten the
attention of the medical community. Two large Harvard studies and several
studies from other countries have shown that milk-drinking men have a
significantly higher risk of prostate cancer compared with men who generally
avoid dairy products.
13–16
In trying to explain this association, researchers have
pointed fingers at milk’s hormonal effects, as well as potentially harmful effects
of its high calcium and phosphate content.
17
For ovarian cancer, the evidence is
mixed, with some studies showing higher risk among milk drinkers and others
showing no increased risk.
18, 19, 20
milk’s selling point has been the calcium it provides. There are, however,
better calcium sources and more effective ways of maintaining strong bones. I
will go into more detail about this later in the chapter.
Making better choices. People who avoid dairy products find no shortage of
great substitutes. Health food stores and regular supermarkets stock soy milk,
rice milk, almond milk, and many others. They come in regular, calcium-
fortified, and low-fat varieties and in plain vanilla, chocolate, and strawberry
flavors. You will want to choose those lowest in fat and sugar. Calcium-fortified
juices have arrived on the market, too. Of course, none of these is necessary.
After the age of weaning, the only beverage that is actually biologically required
is water. Not soda, not juice, not milk—just pure water.
There are many delicious nondairy ice cream substitutes made from soy or
rice milk. In many cases, however, the main reason they are so delicious is that
they contain added sugar. Your taste buds can be easily seduced by these treats,
but your body would be far better off with a bowl of strawberries.
Alternatives to Eggs
There are just two problems with eggs: the yolk and the white. The yolk is where
cholesterol lurks, with around 200 milligrams in a single egg. That’s similar to
an 8-ounce steak.
The yolk also holds the fat, about 5 grams per egg. Egg white has problems
of its own, since it is essentially pure animal protein. As you know by now,
animal protein can present problems for your kidneys, and you are better off
with plant protein.
Can there really be all that fat, cholesterol, and animal protein inside a single
egg? Certainly. Keep in mind that when an egg hatches, a baby chick emerges.
That chick’s body—legs, wings, skin, feathers, internal organs, and everything
else—was formed from what was inside the egg when it was laid. So it was
loaded with cholesterol and other things you do not want. Like all animal
products, eggs have no fiber at all and no complex carbohydrate.
There are plenty of great ways to replace eggs, whether you are hooked on
scrambled eggs for breakfast or baked goods that include eggs. Try these
substitutes.
If a recipe calls for just 1 or 2 eggs, leave them out. Add a couple of extra
tablespoons of water for moisture.
Egg replacement powders are available in many health food stores.
Use 1 heaping tablespoon soy flour or cornstarch plus 2 tablespoons water to
replace each egg in baked products.
Try an egg-size piece of mashed tofu in place of each egg.
Half a mashed banana can be used in muffin and cookie recipes, although it
will provide its own flavor.
For meatless loaves and veggie burgers, use any of the following to bind the
ingredients together: tomato paste, mashed potato, moistened bread crumbs,
or rolled oats.
For a breakfast dish to replace scrambled eggs, scrambled tofu has become
popular. Tofu has a texture very much like egg white and takes on the flavor
of whatever it is cooked with. Be wary of products promoted as no-
cholesterol egg replacements; many are simply egg whites with various
added ingredients.
2. KEEP VEGETABLE OILS TO A MINIMUM
Oils creep in everywhere, it seems: cooking oils, salad oils, vegetable oils used
in baking and in snack foods. Vegetable oils do enjoy a better reputation than
animal fat, and indeed, they have less saturated fat—the kind that raises
cholesterol levels. But we still want to keep all oils to a minimum. Here is why.
First, as we saw above, all fats and oils are loaded with calories. They have 9
calories per gram, which is more than twice the calorie content of carbohydrate
or protein (4 calories per gram). Thus, when it comes to calorie content,
vegetable oils are as fattening as lard. All fats and oils are in fact equally
fattening.
Second, if your goal is to regain as much insulin sensitivity as possible, you
will want to eliminate not only animal fats but also added vegetable oils.
Cleaning the animal fat out of your cellular “locks” does no good if you are
going to clog them with vegetable grease. Here are the sources of these oils.
Fried foods. French fries, potato chips, onion rings, and other fried snacks
are essentially sponges carrying grease from the deep fryer to your body fat
stores.
Added oils. Typical salad dressings and margarines have lots of fat.
Oils used as ingredients. Many packaged foods and sauces include
significant amounts of oil.
Oils used in sautéing. Many recipes begin with the instruction to sauté
onions, garlic, or other ingredients in oil. Some restaurants use oil almost as a
staple.
There are easy ways to avoid all that grease.
Steer clear of fried snacks such as potato chips and french fries.
Top salads with fat-free dressings, lemon juice, balsamic vinegar, or
seasoned rice vinegar.
Use nonstick pans.
Steam-fry onions, garlic, or vegetables in water or another cooking liquid
instead of sautéing the traditional way.
Steam vegetables.
In place of poured oils, consider using cooking spray. If you use just a quick
spritz, the amount of added oil is trivial.
Use fat-free nondairy coffee creamer.
Read package labels. Look for products with no more than 3 grams of fat per
serving or with a percentage of calories from fat of below 10 percent.
When it comes to avoiding greasy foods, some people are eager to make an
exception for olive oil. It seems natural and even chic. But think for a second
about how factories manage to fill a bottle with oil. They take an enormous
number of olives, discard their fiber and pulp, and leave you with the fat.
Gram for gram, olive oil has the same number of calories as beef fat, chicken
fat, and other fats and oils—that is, 9 calories per gram. No other food is more
calorie dense. While olive oil contains a great deal of monounsaturated fat,
which has little or no effect on cholesterol, it also contains saturated fat (about
14 percent), the kind that increases cholesterol and worsens insulin resistance. It
does not matter how expensive the oil is or how “extra virgin” it may be. It still
has more calories and saturated fat than your body is designed to process to
maintain optimal health.
There are, of course, traces of natural vegetable oils in vegetables, fruits,
beans, and grains, but you need not worry about them. Your body does need a
tiny amount of fat, and plants provide it naturally. We run into problems when
oils are concentrated, as they are in fried foods, oily sauces, and recipes with
added oils.
A few plant foods, such as nuts, seeds, olives, avocados, and some soy
products, are naturally high in oil. If you are trying to lose weight or tackle
diabetes, you will want to avoid them.
What about Good Fats?
There are two types of fat your body actually needs. Their technical names are
alpha-linolenic acid and linoleic acid. These terms are not important; you will
never see them on an ingredients list. What is important to know is that you need
only a tiny amount of them. The body’s need for these essential fats is no more
than 2 to 3 percent of your daily calorie intake.
Where do you find them? Beans, vegetables, and fruits are very low in fat
overall, but the traces they do contain are relatively rich in “good” fat—that is,
alpha-linolenic acid. This is the basic omega-3 fat that your body uses to produce
other good fats. Nuts, seeds, and soy products contain larger amounts. Linoleic
acid is found in many plant foods, too.
Some people boost the omega-3 fats in their diets. If you are doing this, be
careful: All fats, good and bad, are equally fattening, and many contain things
your body does not need. Fish oil, for example, contains plenty of saturated fat
along with its omega-3s.
The best way to get the right kind and amount of fat in your diet is to skip
animal products, fried foods, and oily food products and get your nutrition from
vegetables, fruits, beans, and whole grains.
Does it really matter whether or not we avoid animal products and added
oils? Absolutely. A typical North American or European diet might provide 80 to
100 grams of fat per day, or even more. Switching from beef to chicken and fish,
keeping portions modest, and limiting added oils will trim this to about 60
grams. But setting animal products aside and avoiding added oils can drop this
number to close to 20 grams. In the process, your cholesterol intake, which
would be well over 200 milligrams per day on an unmodified diet, will drop to
zero. Every cell in your body will thank you.
3. FAVOR FOODS WITH A LOW GLYCEMIC INDEX
You will find this third guideline very useful. The glycemic index (GI) is a
handy tool that was invented by David Jenkins, MD, PhD, DSc, a physician and
researcher at the University of Toronto.
21
It is simply a number that indicates
how rapidly any given food releases sugar into the bloodstream. A food with a
high GI releases sugar into the blood quickly.
One example is white bread. If a molecule of carbohydrate in bread was
greatly magnified, it would look like a string of beads. Each bead is a molecule
of sugar (glucose). In your digestive tract, these beads separate and pass into
your bloodstream.
With white bread, this process is quick. The string of beads rapidly
disintegrates, and the individual glucose molecules race into your bloodstream.
If you were to check your blood sugar after eating the bread, you would see the
result. White bread has a high GI, meaning it has a pronounced effect on your
blood glucose.
In contrast, pumpernickel bread has a low GI.
*
Its “beads” come apart more
slowly, passing into the bloodstream bit by bit. It has much less effect on your
blood sugar.
In a nutshell, high-GI foods tend to have a greater effect on your blood sugar,
and low-GI foods have less effect.
I should mention that when researchers measure the GI of individual foods,
they test volunteers who do not have diabetes, so a food that does not raise their
blood sugar very much could raise yours somewhat more. However, the point of
the glycemic index is to allow us to rate foods—to compare one against another
—so we can choose the best ones.
If you were to do an online search for information about the glycemic Index,
you would soon discover a mind-numbing array of tables from a variety of
sources, none of which agree with each other. That is because the GI of any food
can vary depending on the brand, how it was prepared, and other factors. So,
let’s keep things simple. Here is all you need to know about the GI:
Glycemic Index at a Glance
White and wheat breads are high GI. Rye and pumpernickel are better
choices.
Table sugar is high GI. Fruits are better. They give you a sweet taste with a
suprisingly low GI.
White baking potatoes are high GI. Sweet potatoes are lower.
Most cold cereals are high GI (especially if they have a toy inside the box).
Oatmeal and bran cereals are better.
And here are a few more tips, for extra credit:
Beans and their relatives (lentils, peas) are always low GI.
Green leafy vegetables can also be considered low GI (although they have so
little starch that their GIs typically have not been calculated).
Pasta is a low-GI food. Because pasta is compacted (unlike bread), it digests
slowly and releases its natural sugars only gradually. More on this below.
Barley, bulgur, and parboiled (converted) rice all have a low GI value.
Now, if you have type 2 diabetes, any food with carbohydrate in it will push
your blood sugar up to a degree. In fact, a rise in blood glucose after a meal is
normal, and if your cells are insulin resistant, it takes a bit more time for glucose
in your bloodstream to pass into your cells. This does not mean, however, that
you should avoid foods that contain carbohydrate. What it means is that you will
want to take steps to reduce your insulin resistance, as outlined in this chapter.
Among carbohydrates, the best are those with a low GI.
The reason I mention this is that sometimes people with type 2 diabetes shun
carbohydrates. They avoid rice, beans, pasta, and all the rest and load up on
chicken, fish, and eggs because these foods have no carbohydrate. But over the
long run, they find their blood sugar does not improve; their level gets worse, so
they need more and more medicine. It makes sense when you think about the
fact that these foods contribute a load of fat and aggravate the accumulation of
fat in cells—more gum in the locks, so to speak. Greasy meals today mean
insulin resistance tomorrow.
It may surprise you to learn that pasta has a low GI. It does, particularly if it
is served al dente, that is, not overcooked. Of course, pasta is made from wheat
flour, so you may think it would spike your blood sugar in the same way as
wheat bread. But that is not the case.
Pasta actually gives us a little lesson in why some foods have a high GI,
while the GI of others is low.
Let’s say we are making bread dough. We add a bit of yeast to the flour to
make the bread rise. The yeast causes many tiny air pockets to form, which is
what makes bread different from, say, a shingle. Now, as you eat the baked
bread, your stomach acid and digestive enzymes enter those air pockets and
rapidly break the molecules of flour into individual sugar molecules that then
pass from your digestive tract into your bloodstream. Even whole wheat bread,
with shreds of fiber remaining, is easy pickings for digestive enzymes—they
have no difficulty entering the air pockets and digesting the starch in the bread.
pasta is different. It is not made with yeast, so it has no air pockets. If bread
is like a pile of tiny twigs, ready to ignite with a single spark, pasta is like a cord
of logs—it is much more compacted and “catches fire” more slowly. Even if you
chew pasta thoroughly, there is no way it can digest as rapidly as bread—and
that’s why it has a lower GI.
The take-home lesson is that processing foods—pulverizing grains into flour
or using yeast to make dough rise, for example—starts the digestive process
before you even put the food on your plate. An intact grain is slow to come apart
and release glucose into your bloodstream, while a heavily processed grain is
likely to disintegrate quickly. Thus, old-fashioned oatmeal, which consists of
whole oats, has a low GI. But quick-cooking oatmeal is made by slicing the oat
grains into fragments. That allows it to cook faster and to digest faster—which
means a higher GI.
If you would like to look up the GI of individual foods, you can take a look
at a Web site established at the University of Sydney in Australia:
glycemicindex.com. Just type in the name of the food, and all the testing results
will appear.
“Does it really matter?” you may be asking. “Can it really make a difference
if my oatmeal is old-fashioned instead of instant, or if I bring beans, green leafy
vegetables, and barley soups into my life?” Jennie Brand-Miller, PhD, of the
University of Sydney, answered that question by analyzing the combined results
of 14 studies on the glycemic index that included a total of 356 participants. She
found that choosing low-GI foods reduces hemoglobin A1C by 0.3 to 0.4
percentage point. In some studies, the difference was as much as 0.6 point.
23
Studies showed a similar benefit for both type 1 and type 2 diabetes.
This advantage is over and above that of the other diet changes you are
making. As you will remember from Chapter 2, the combined diet changes
described in this book—avoiding animal products, minimizing oils, and eating
low-GI foods—added up to an A1C drop of 1.2 percentage points, on average, in
our research. That average includes people who did not have very far to drop as
well as some participants who started with A1Cs in the 9 to 10 percent range and
dropped several percentage points. These results are stronger than any single
drug is likely to bring. For some people, that is all it takes to return their A1C to
the normal range.
TWO IMPORTANT SUPPLEMENTS
Fruits, vegetables, beans, and grains provide the healthy nutrition you need.
Eating these foods, you are much better nourished than you would be on a
meaty, dairy-filled diet, because these healthy, plant-based foods are rich in fiber,
vitamins, and other plant-based nutrients, while helping you skip unhealthful fats
and cholesterol. Even so, there are two supplements that are important for you to
know about.
Vitamin B
12
. Vitamin B
12
is essential for healthy nerves and healthy blood
cells. If your B
12
level runs low, you could have nerve symptoms that are
permanent. But this vitamin is not made by animals or plants. Rather, it is
produced by bacteria. How does this substance get from bacteria to the human
body? Some have suggested that before the advent of modern hygiene, there
were traces of bacteria in the soil, on vegetables and fruits, on our fingers, or in
our mouths that provided the tiny traces of vitamin B
12
that we need. Whether
that was ever true, it is certainly not a reliable source today. Bacteria in animals’
intestinal tracts produce vitamin B
12
, and traces of it end up in meat and other
animal products. The problem with these sources is that along with it come
cholesterol, fat, and animal proteins. B
12
is also added to some foods, as you will
sometimes see on the package labels of breakfast cereals, soymilk, nutritional
yeast, and other products. The best source is a vitamin B
12
supplement, which
you will find at any drugstore or health food store, and you should take it daily.
The dose is not especially important, because all common brands have more than
the recommended daily allowance, and even high doses of B
12
do not appear to
be dangerous.
Vitamin D. Technically, vitamin D is not a vitamin at all. It’s actually a
hormone produced by sunlight on your skin. Once activated in your liver and
kidneys, it helps you absorb calcium and helps protect your cells against cancer,
among other functions.
If you get plenty of sun, you do not need any vitamin D in your diet. But if
you do not get regular sun exposure, a vitamin D supplement is important. A
reasonable daily dose is 2,000 IU.
PUTTING THE RIGHT FUEL IN YOUR TANK
Now we have covered the basics, the three guidelines that work together to help
you regain control: avoiding animal products, keeping oils to a minimum, and
favoring low-GI foods.
These guidelines work together. Meeting one of them is not enough. For
example, jelly beans can be vegan, and they are low in oil. Because they are
essentially solid sugar, though, they have a high GI and will spike your blood
glucose.
Similarly, a snack cake loaded with butter can have a very low GI because
butter contains no carbohydrate and may even slow the absorption of glucose
you eat. But the snack cake is not vegan, nor is it low in fat. It will contribute to
insulin resistance, and you want to steer clear of it. The low GI is not a reason to
eat it if it does not meet our other criteria.
The three guidelines together are a powerful combination. Nancy’s A1C was
8.3 percent at the beginning of our study. As she began the healthy diet changes,
it rapidly slid under 7.0, even while she reduced her medications. For Vance,
initial A1C testing showed a value of 9.5 percent, but as the weeks went by, it
dropped and dropped and dropped. By the study’s conclusion, his A1C was a
healthy 5.3 percent.
Now, before we plan out your breakfast, lunch, and dinner, let me show you
how these three principles translate into changes inside your body. Just as a car
performs dramatically better when it has the fuel it was designed for, your body
performs far better when you give it the foods it needs.
Increased insulin sensitivity. As you know by now, evidence shows that a
diet change can have a quick and decisive influence on the amount of fat inside
your cells. As the amount of fat drops, your cells become more and more
sensitive to insulin, allowing your blood sugar to come down. If your insulin
resistance was previously worsening and your medication doses increasing, the
process begins to reverse.
This can happen remarkably quickly. In fact, it can happen so quickly that it
is essential, if you are using insulin or any drug that increases insulin secretion
(for example, glipizide, glimepiride, glyburide, nateglinide, or repaglinide), that
you be in close touch with your doctor. As your cells regain their insulin
sensitivity, you will become more and more like a healthy person who is taking
drugs he or she no longer needs.
The combination of a healthy diet and the drugs you have been taking can
drive your blood sugar down to healthful levels and then below them, to
hypoglycemia. In other words, your blood sugar can fall too low, which can be
dangerous. Your doctor will lower your medication doses or even discontinue
your medications as necessary, which will solve the problem. Now, do not throw
your medicines away on your own. Your doctor will guide you. And do not be
frightened by this return to health. It is a wonderful feeling to discover that your
insulin sensitivity is improving day by day. When your doctor says it’s time to
cut back on medication or stop a drug altogether, it is as if time is moving
backward.
Chapter 7 has important details on how to prevent and treat hypoglycemic
episodes. Please read it carefully before you change your diet.
Easy weight control. If you have been hoping to lose weight, that process
has just begun. On average, the diet you are beginning causes a weight loss of
about 1 pound per week. As time goes on, it adds up to an impressive change.
“How does this work?” you may ask. How can you lose weight if you are
paying no attention at all to portion sizes, calories, and carbohydrates? There are
three main reasons.
First, the foods have very little fat, so you are eliminating the main source of
unwanted calories.
Second, the vegetables, fruits, beans, and whole grains you are bringing into
your diet give you a healthy dose of fiber, which is filling enough to turn off
your appetite a bit sooner than would happen without them. On average, each 14
grams of fiber cuts about 10 percent off your calorie intake. A person who
normally eats 2,000 calories per day and then starts to add an extra 14 grams of
fiber daily will tend to feel full after eating 1,800 calories.
24
Third, these foods cause a slight boost in your after-meal calorie burn.
Normally, you burn calories faster after a meal due to the processes of digestion.
Our studies have shown that a low-fat vegan diet increases this after-meal burn,
giving you an extra edge.
25
I will go over this in more detail in Chapter 6. For
now, just enjoy the weight control that is kicking in on its own.
Losing excess weight feels great, of course, but weight loss improves your
insulin sensitivity in addition to the effects of the diet change itself.
Easy cholesterol control. If you have had a cholesterol problem, the
program you are now beginning is far more powerful than typical cholesterol-
lowering diets. This should be no surprise. Your new diet is not low in
cholesterol; it has no cholesterol at all. It also has no animal fat, which is
important because animal fat (like other sources of saturated fat) encourages
your body to make cholesterol. They are all gone now. You have replaced them
with cholesterol-lowering oats, soy, and other botanical magicians, as you will
see in more detail in Chapter 12.
Your arteries are starting to breathe a sigh of relief. The damage of diabetes
is done to the arteries, for the most part, leading to problems in your heart, eyes,
kidneys, and nerves. But now, you are inhibiting that process, and bringing your
cholesterol level down is part of it. You are following the kind of diet used in
programs to reverse heart disease.
Again, do not throw your medications away and cancel your doctor
appointments. Your doctor can size up your heart health and track your progress.
Reversing symptoms. A team of California researchers used a low-fat vegan
diet, combined with exercise, in a group of 21 people with type 2 diabetes, all of
whom had painful neuropathy—the nerve symptoms that arise as the nerves are
damaged. In just 2 weeks, 17 of the 21 reported complete cessation of their nerve
symptoms, and the remaining 4 had noticeable improvements.
26
So our research
team did a test of a low-fat, vegan diet alone—without exercise—and found that,
indeed, it can improve nerve function and reduce neuropathy symptoms.
27
other researchers have found that some of the changes in the eye—exudates
in the retina—that sometimes occur in diabetes start to improve or even
disappear when people make a healthy diet change. The loss of protein through
the kidneys can also diminish. You will find more details on all of these in
Chapter 13.
FIRST STEPS
One of the things we have carefully tested with this program is how people feel
about it. Bottom line: Although you will be making major changes in your menu
that are designed to bring you uncompromised good health, this is perhaps the
easiest diet change to stick with over the long run. Partly, that is because it is not
a “diet.” It is a different way of regarding food—a much better way of thinking
about and enjoying it. Also, you will never go hungry and never tease yourself
with minuscule portions of foods you love.
Let me show you the steps that make it that way. For the moment, you are
not actually going to change anything. I just want to walk you through the steps
that will get you started.
Step 1: Check Out the Possibilities
Before you jump into a new way of eating, take a week and check out a few
recipes and new food products. Look through the next chapter for ideas. You will
find a great many possibilities to get you started. If you rarely cook and tend to
eat at restaurants, the next chapter will have many tips on things you can look
for.
Your goal is to identify healthy breakfasts, lunches, and dinners that you
really like. That means meals that meet all of our guidelines (no animal products,
minimal vegetable oils, and low GI) and appeal to your tastes.
Remember that this new way of eating does not mean making a new dish
every night. William Castelli, MD, former director of the Framingham heart
Study, used to say that most of us tend to stick to our favorite meals. We may
have four or five different dinners we like, and we pick from that repertoire night
after night. All you need to do is to find healthy meals that suit your tastes, and
you are set. A week is more than enough time to do that.
Step 2: Pick 3 Weeks
Some people like to ease their way gradually into a healthier diet pattern. If you
are among that group, go ahead and take your time getting to know healthier
foods. But I advise a different approach. Mark a 3-week period on your calendar
when you plan to embrace this program. Before you reach your start date,
identify meals that fit our criteria and appeal to you. When the start day arrives,
commit yourself completely for 21 days.
As I tell our research participants, this is not the time to stick your toe in the
swimming pool; it’s time to jump in. Really do it. Make it all low-fat vegan, all
the time. There are two reasons for this.
First, it gives you fast results. If you have a healthy meal on monday and
another on Saturday, your body will not notice any difference. But if you do it at
every meal, gains come quickly. Give yourself a chance to see how it feels to be
on as perfect a diet as possible.
The second reason is that a diet change really is like getting into a swimming
pool. If you ease your way into the water bit by bit, it is a painful process. But if
you plunge in, very soon you see that the water feels fine. Let me explain.
Did you ever switch from whole milk to fat-free milk? If you are like most
people, that first glass of fat-free seemed watery and maybe even discolored.
After a couple of weeks, though, you became totally used to the lighter taste.
Before long, whole milk seemed thick and distasteful.
Now, I am not suggesting that fat-free milk is a health food. As you have
seen, there are good reasons to avoid it. But when you lighten your diet, your
tastes rapidly change. Very soon, you come to prefer the new, healthier taste.
You will find that your taste buds have a memory of about 3 weeks, and
jumping into the diet change allows them to adjust quickly. Instead of pining
over the unhealthy foods you have left behind, you will be surprised to find that
you miss them very little.
If a 100 percent diet change sounds like a tall order, let me make it a bit more
approachable. You do not need to commit to it forever; you just need to give it a
try. At this point, there’s no need to swear off bacon double cheeseburgers,
pledge your loyalty to oatmeal, or make any other daunting promises. Just give it
3 weeks. During that time, really do it 100 percent, and you will get a good sense
of what the diet will do while still keeping all your options open.
GET TO KNOW TRANSITION FOODS
Modern technology has brought us plenty of modern annoyances (ringing cell
phones, crowded freeways, and junk e-mail), but once in a while, it’s actually
useful. The food industry has managed to mimic unhealthy foods with more
healthful varieties.
The hot dog, long reviled by nutritionists, gained a measure of respectability
once food scientists figured out how to transform soybeans into a frankfurter.
Veggie hot dogs, veggie burgers, and veggie sausages debuted in health food
stores but are now sold everywhere. Even deli salami, turkey, chicken, and
bologna slices have soy or wheat counterparts that look and taste very much like
the real thing, with zero animal fat and cholesterol.
These foods are hardly the pinnacle of fine dining, but they are practical. If
you have children, they are an absolute gift. If you saw what goes into a real hot
dog, it would become the last thing you would want to see heading for your
child’s mouth. But a veggie version is something you can bring home with pride
—and your kids will love them. These products help you through the transition
to a broader range of healthy foods.
Soy milk has arrived big time. Once, buying soy milk meant shopping at a
health food store that was dingy and dark. The cashier was wearing a tie-dyed
shirt, his name was Sunshine, and folk music was playing in the background.
Well, those days are gone. Health food stores are big businesses that know a
thing or two about customer service. Regular supermarkets stock dozens of
flavors of soy milk, along with rice milk, almond milk, oat milk, and other
varieties, too, and people from all walks of life enjoy them.
As you shop for meat and dairy substitutes, take a look at the labels. When
you check the ingredient lists, you will see that some products are not quite as
vegan as you might like because they include egg whites or dairy proteins.
Choose the vegan versions, and look for those that are lowest in fat.
COMPLETE NUTRITION
When you follow the nutrition guidelines in this chapter, your diet is likely to
improve dramatically.
28
Not only will you skip all the animal fat and cholesterol,
you will get much more of the healthy nutrients your body needs: soluble fiber to
cut cholesterol, healthy vitamins to reduce cancer risk, potassium to lower blood
pressure, and antioxidants to knock out free radicals, to name a few.
Even so, you are making a big change, and you are likely to wonder whether
you are missing out on anything. Let me offer a word of reassurance. If you
choose your meals from a variety of whole grains, legumes, vegetables, and
fruits and take my advice about vitamin B
12
and vitamin D, above, you will have
your bases covered.
here’s where the healthy nutrients are on your plate.
Protein. Your body uses protein to build and repair body tissues. Proteins are
made up of small molecules called amino acids. All the proteins in your skin,
muscles, bones, and internal organs are built from various combinations of about
20 different amino acids.
A healthy diet of beans, grains, vegetables, and fruits provides all the protein
you need. In fact, you are better off getting protein from plant sources. While
animal protein can be hard on the delicate tissues of the kidneys, plant proteins
appear to be free of this problem. They are also free of the risks of calcium loss
and kidney stones associated with animal protein.
29
Animal protein tends to
cause calcium to pass through the kidneys and into the urine. In the process,
calcium is not only lost, but it ends up in your urinary tract, where it can cause
stones.
In years past, some nutritionists believed that vegetarians needed to carefully
combine various foods in order to get adequate protein. The idea was that foods
from plants might be missing one or more amino acids, so only combining foods
in certain ways could ensure that you got them all. This notion was set aside long
ago. The Academy of Nutrition and Dietetics’ official position statements make
it clear that plant-based diets provide plenty of protein without combining foods
in any particular way.
30
If, for any reason, you wish to increase your protein
intake, turn to the bean group. You will find extra amounts of protein in soy
products, such as tofu, tempeh, and soy milk, and in wheat derivatives (e.g.,
seitan) used to make meat substitutes.
Calcium. For many people, calcium and milk are almost synonymous. They
think that milk will build strong bones and protect against fractures later in life.
Research has shown, however, that milk’s benefits are, for the most part, a myth.
Studies do not show much benefit for the bones from drinking milk. How can
that be? Well, only about one-third of milk’s calcium is absorbed by the body.
The other two-thirds simply passes out with the wastes. In addition, milk
contains animal protein and sodium, both of which tend to increase calcium loss
through the kidneys.
Do not misunderstand me here—you need some calcium in your diet, but it
should come from healthful sources, namely green leafy vegetables and beans.
While there is somewhat less calcium in broccoli than in milk, the absorption
fraction—the percentage that your body can actually use—is higher for broccoli
and nearly all other greens than for milk. There is one exception: Spinach is high
in calcium, but the absorption fraction is very low.
Greens and beans will give you the calcium your body needs. If you are
looking for extra calcium for whatever reason, you can find plenty more in
fortified juices and soy milks.
To maintain calcium balance, however, it is important not only to take in an
adequate amount but also to minimize losses. Animal protein causes your body
to lose calcium through the kidneys, and it can be measured in the urine. Studies
of high-protein diets, such as the Atkins Diet, dramatically demonstrate the
losses: Such diets increased calcium loss by more than 50 percent.
31
It is also
important to limit sodium (salt) and get vitamin D from either sunlight or
supplements. Vegetables and fruits promote bone strength for reasons that are
not entirely clear, and exercise gives your bones a reason to live. It is a strong
determiner of bone health. Finally, it is also important to avoid tobacco, since
smoking increases fracture risk.
Iron. Iron is a double-edged sword. You need iron to build hemoglobin,
which your red blood cells use to carry oxygen from your lungs to your body
tissues. But too much iron can be toxic. It can increase the risk of heart problems
and may even worsen insulin resistance.
Iron encourages the production of unstable molecules called free radicals,
which can damage your body’s delicate tissues and are linked to heart disease,
cancer, and even certain aspects of the aging process.
The most healthful iron sources are the same foods that bring you calcium:
beans and green leafy vegetables. They are rich in iron but carry it in a special
form called non-heme iron. Your body easily absorbs this form when it’s in need
of more iron, but the iron passes harmlessly out of the body when you have all
you need. In contrast, meats contain heme iron, which is like an uninvited guest
at your party: It barges in whether you need it or not. Over the long run, meat
eaters tend to accumulate too much iron.
If you are anemic, do not rush out and buy iron supplements, or worse, add
lots of meat to your diet. Instead, work with your doctor to find out what kind of
anemia you have and why it occurred. Anemia can be a sign of kidney disease; it
can be caused by certain drugs; and it can be a sign of blood loss from your
digestive tract caused by gastrointestinal irritation or even colon cancer. It is
essential that you be evaluated and treated appropriately.
If you do need extra iron, turn first to greens and beans. Vitamin C–rich
foods, such as fruits and vegetables, increase the absorption of iron from the
other foods you eat, and avoiding dairy products helps, too. They are very low in
iron and actually reduce its absorption from your digestive tract.
Zinc. Zinc plays important roles in immune function, wound healing, and
many other biological functions, but as with iron, you can have too much of a
good thing. The most healthful sources include legumes, nuts, and fortified
breakfast cereals (e.g., Post Grape-Nuts, bran flakes, and granola).
Fat. Good fats, bad fats, and too much fat—how do we make sense of it all?
The most important fat fact is this: Your body’s actual fat requirement is
minuscule, as you saw earlier. Most people in Western countries get many times
the needed amount. With meats and dairy products front and center in their diets,
they not only get too much fat overall, they also get the wrong kind—saturated
fat, which boosts cholesterol and aggravates insulin resistance.
Nuts, seeds, avocados, olives, and full-fat soy products are also high in fat.
Although they are low in saturated fat, the overall amount is high, and you
should limit these foods accordingly.
As you also saw earlier, most vegetables, fruits, and beans contain very little
fat, and what they do have is a healthful mixture, including traces of the essential
fats alpha-linolenic acid and linoleic acid.
If, for any medical reason, you are increasing your oil intake, healthful
sources of omega-3 fats include walnuts, soy products, flaxseed, and, in
concentrated form, flax, linseed, canola, and walnut oils. Health food stores even
sell omega-3 supplements (e.g., DHA) drawn entirely from botanical sources.
They are a better choice than fish oils. Omega-6 oils are also sometimes used for
health conditions such as arthritis, usually in the form of evening primrose oil,
borage oil, black currant oil, or hemp oil. They should be thought of as
medicinal supplements rather than as foods.
In the next chapter, you will get started with your new program, and then, in
Chapter 7, I will show you how to track your progress.
*
The glycemic index of a food is determined by feeding a portion containing 50 grams of carbohydrate to
10 healthy people after an overnight fast. Blood glucose is tested at 15- to 30-minute intervals over the next
2 hours, and the result is compared to feeding the same amount of glucose (or, in some cases, white bread).
A GI below 100 means the food has less effect on blood sugar, compared to glucose. A higher number
means the test food has agreater effect.
22
CHAPTER 5
How to Get Started
By now, you understand the principles for building a healthful diet and are ready
to get started with foods that will tame your blood sugar, help you lose weight,
and go a long way toward lowering your blood pressure and cholesterol. But you
are no doubt asking, how do I start? And will it be easy? Will I be able to stick
with it?
Let me put your mind at ease. The two-step system described in the last
chapter makes this very easy. You just take a week to “check out the
possibilities” and then do a 3-week “test drive.” Let’s revisit this in more detail:
STEP 1: CHECK OUT THE POSSIBILITIES
Take a week, and see which healthy foods you like best. You are not going to
eliminate anything. Rather, you’ll try out new products, new recipes, and new
tastes, and perhaps get reacquainted with a few healthy tastes you may have
forgotten.
Take out a sheet of paper and jot down the headings “Breakfast,” “Lunch,”
“Dinner,” and “Snacks.” over the next 7 days, write down—in each of the four
categories—foods you like that meet the three guidelines set out in the previous
chapter. In a nutshell, we are choosing foods that are:
Vegan. They contain no animal products. This means no meat, fish, dairy
products, or eggs—not even a little bit. The idea is to clean the animal fat,
animal protein, and cholesterol out of your diet. If you skipped to this chapter
and are wondering why these steps are important, please go back and read the
preceding chapter.
Low fat. You will use little or no added oil and omit other fatty ingredients.
If you are reading labels, choose foods with no more than 3 grams of fat per
serving.
Low glycemic index. You will favor low-GI foods. This means generally
avoiding sugar, white bread products, baking potatoes, most cold cereals, and a
few other foods. Most other vegan foods are fine. Certain foods have an
especially low GI value: beans and other legumes, green leafy vegetables, most
fruits, barley (which is great in soups), and the many foods that are made from
them. Surprisingly, pasta has a low glycemic index, unlike other wheat products.
Healthful Breakfast Ideas
Under “Breakfast,” your list may well be similar to what you are eating already.
Here are a few suggestions.
Hot cereals such as oatmeal or other whole grain cereal with cinnamon,
raisins, and/or applesauce (no milk)
Cold cereals such as bran flakes with fat-free soy or rice milk and/or berries,
peaches, or bananas
Melon, cantaloupe, bananas, or any other fruit
Rye or pumpernickel toast topped with cinnamon (no butter or margarine)
If you like extra protein, try these.
Veggie sausage
Veggie bacon
Scrambled tofu
Breakfast burritos filled with “refried” beans, lettuce, and tomato (no egg or
cheese)
English baked beans or chickpeas
Pumpernickel bread with hummus
Here are a few thoughts about some good breakfast choices.
Oatmeal. Most of our research participants make old-fashioned oatmeal a
part of their morning routine, and for good reason. Oats are rich in soluble fiber
—the kind that gets creamy in water and removes cholesterol from your body.
(Wheat and rice are high in insoluble fiber.) But that humble bowl of oatmeal
does more than that. It helps bring your blood sugar under control, and its high
fiber content helps you lose weight.
An additional advantage comes from what oats do not have: cholesterol and
animal fat. A bacon-and-eggs breakfast has a strikingly large amount of both.
Generally speaking, old-fashioned oatmeal is better than instant or 1-minute
varieties, although even these quick-cooking versions are far better than bacon
and eggs. The more intact the grain, the lower the GI, and the longer the cereal
keeps you satisfied. See Old-fashioned oatmealfor tips on making the perfect
bowl of hot oatmeal.
For an extra blood sugar–lowering effect, top your bowl with cinnamon (see
Which Supplements Should You Take?” for details about how cinnamon affects
blood sugar). Or add raisins, berries, or just about any fruit or mix of fruits you
like, but set the milk and sugar aside. Within just a day or two, you will break the
habit of adding these unnecessary and unhealthful toppings. If you just cannot
imagine oatmeal without milk, splash on some soy milk or rice milk; you will
skip the animal fat and cholesterol of cow’s milk.
Most dry cereals have a high GI, but oatmeal is in a good GI range, as is bran
cereal. They will keep you full and satisfied and help keep your blood sugar
steady.
Veggie sausage or bacon. Regular sausage and bacon are loaded with
cholesterol and fat and are among the most unhealthful foods on anyone’s
grocery list. But if you are unable to imagine breakfast without these meats, food
manufacturers have come to your rescue with vegan versions, and most
supermarkets and all health food stores now carry several varieties. If they are
new to you, think of them as a liberal interpretation of the original; they are tasty
and high in protein. Read the package labels, and choose those that omit animal
ingredients (some are made with egg white, which is concentrated animal protein
that you want to avoid) and are as low in fat as possible.
Scrambled tofu. Tofu is almost identical to egg white—it has little flavor of
its own but quickly takes on the flavors of whatever spices or sauces it is cooked
with. Scrambled tofu is a great substitute for scrambled eggs—it has all the taste
but no cholesterol, animal fat, or animal protein. Supermarkets sell scrambled
tofu seasoning mixes, usually shelved near boxed rices or in the health food
section. Just follow the package directions.
Breakfast burritos. No time for breakfast? Breakfast burritos to the rescue.
You buy them frozen, pop them in the microwave, and in a couple of minutes,
you have a hearty, healthy breakfast. Health food stores and most regular grocery
stores stock a variety of frozen burritos made with beans, tofu, tomatoes, and
other ingredients. You can also make your own, of course, perhaps on the
weekend, and refrigerate or freeze them so they are handy for those busy
mornings.
Bagels. If bagels are your thing, favor pumpernickel bagels, which have a
lower GI than white bagels.
A Few Things Not on the Breakfast Menu
Just to state the obvious, eggs are off the list. A single egg has around 200
milligrams of cholesterol—similar to an 8-ounce steak—plus a load of saturated
fat, the kind that tends to raise cholesterol. The white of the egg presents a big
dose of animal protein that you want to avoid. As you know, getting your protein
from plant sources is better for your kidneys and your long-term bone health.
Skip eggs and egg replacements such as Egg Beaters, which are made from egg
whites.
Of course, breakfast meats are off the list, too, including turkey sausage as
well as pork or beef varieties. They all have cholesterol and animal protein.
Forget doughnuts, Danishes, and muffins. To see why, set one on a napkin
for a few minutes, then look at how much grease has leached out. That grease is
just waiting to fatten you up, boost your cholesterol, and worsen your insulin
resistance.
A Balanced Breakfast
You may wish to start your breakfast with a high-protein food such as veggie
sausage and follow it with a starchier food like oatmeal with cinnamon and
raisins or a sweet food such as fruit. It’s not that you need extra protein; there is
actually plenty of protein in any typical meal built from vegetables, grains, and
beans. Here’s why starting with a high-protein food can be helpful.
Starchy or sugary foods naturally increase the production of serotonin—the
same feel-good chemical that is boosted by antidepressants such as fluoxetine
(Prozac) and sertraline (Zoloft)—in the brain. Now, that’s a nice benefit, but for
some people, the result is postbreakfast drowsiness. In fact, some people actually
use starchy foods as a remedy for insomnia. A high-protein food blocks the
serotonin-producing action, boosting your energy. Any high-protein food will
do: veggie sausage, veggie bacon, scrambled tofu, beans, or even a spoonful or
two of chickpeas—the kind you’d normally throw on a salad.
So, during this first week, explore the various breakfast possibilities and jot
down your favorites.
Sample 1-Day Menu
Breakfast
Veggie sausage
Rye toast
Oatmeal with cinnamon and raisins
Sliced cantaloupe
Lunch
Green salad
Split pea soup
Hummus sandwich on rye bread with sliced tomato and cucumber
Dinner
Spinach salad with cherry tomatoes
Angel hair pasta with tomato and mushroom sauce
Steamed broccoli
Snacks
Apples, oranges, bananas
Healthful Lunch Ideas
Okay, let’s move on to lunch. Here are a few ideas, but you will no doubt have
many more.
Salads
Garden salad with fat-free dressing, lemon juice, or soy or teriyaki sauce
Three-bean salad
Pasta salad
Black bean and corn salad
Grain-based salad, such as noodles, couscous, bulgur, or rice
Soups
Minestrone
Mixed vegetable
Lentil
Mushroom barley
Black bean
Vegetarian chili
Split pea
Instant and prepared soups are okay as long as they are low-fat and free of
animal products.
Sandwiches/Wraps
CLT: sliced cucumber, lettuce, and sliced tomato on rye bread with Dijon
mustard. Or use veggie bacon, rather than cucumber, if you like.
Hummus on a whole wheat pita with grated carrots, sprouts, and sliced
cucumber
Sandwich made with fat-free meat alternatives such as veggie turkey,
bologna, or pepperoni slices or barbecued seitan (wheat gluten), plus your
favorite sandwich veggies on rye bread
Black bean dip, bell pepper and tomato slices, and lettuce wrapped in a
whole wheat tortilla
Italian eggplant sub: baked eggplant slices, pizza sauce, and mushrooms on a
whole grain sub roll
Black bean and sweet potato burrito with corn and tomatoes
Extras
Fresh fruit
Chickpeas
Cut-up vegetables
Here are a few more details on good lunch choices.
Salads. Salads vary from the simple lettuce-and-tomato variety to pasta
salads, three-bean salads, Asian salads, fruit salads, and many others.
If you start with salad greens, regular lettuce is fine, but do not shy away
from baby spinach, arugula, and other greens. Add cucumber, artichoke hearts,
and tomato slices and by all means, chickpeas, kidney beans, or other legumes to
your salad. They provide plenty of nutrition and are great at holding your blood
sugar steady.
For convenience, supermarkets carry commercial three-bean and four-bean
salads in jars, which are ready when you are. Many stores also have well-stocked
salad bars.
When you choose dressings, look for fat-free vegan varieties, which are easy
to find at many supermarkets.
Soups. Soup is a great lunch starter, or a big bowl of hearty soup can be your
lunch. Loaded with vegetables, beans, lentils, barley or other grains, and
wonderful flavors, soups are satisfying and wonderfully healthful. If you cook
up a big pot on the weekend, you will be ready for the week ahead.
If you are looking for convenience, Manischewitz brand dried soup mixes
are time-savers. Just add them to boiling water and let them simmer. If you like,
add tomatoes, green chiles, or any frozen or fresh vegetables. Stir a tablespoon
or two of nutritional yeast into each bowl for a savory touch. If you add extra
carrots, tomatoes, frozen vegetables (e.g., broccoli, kale, cauliflower, or green
beans), and spices, you will turn your soup into a stew.
If you’d like to let someone else do the cooking, your supermarket has an
endless variety of canned and frozen soups. You need to be selective, but you
will find plenty that meet our requirements. Lentil, minestrone, and vegetarian
vegetable are good choices. Tabatchnick frozen soups offer generous servings of
split pea, mushroom barley, and other flavors with simple ingredients and
virtually no fat.
Instant soup comes in a cup and just needs hot water. You might keep a few
cups in your desk drawer for emergencies.
To have homemade soup anywhere, pick up an insulated bottle, such as a
Thermos, so you can just fill it with soup and take it to work. Your co-workers
will wish they had done the same.
One caveat about prepared soups: Some manufacturers overdo it with salt, so
it pays to choose lower-sodium brands. Aim to keep your total daily sodium
intake to less than 1,500 milligrams.
Sandwiches. Sandwiches are quick and portable, and with the enormous
variety of ingredients available these days, they can be healthful, too.
Start with a lower-GI bread, such as rye or pumpernickel. Try any or all of
the following fillings.
Hummus is a Middle Eastern dish that has become popular in North
America. It is made from chickpeas and spices and has a texture vaguely
reminiscent of peanut butter but a milder flavor. Unfortunately, many
commercial brands are too high in fat, but who needs them? With a food
processor, it takes only about 5 minutes to make your own, and a big batch will
last for days.
Meatless deli slices have all the taste of bologna, sliced turkey, or ham with
none of the animal fat or cholesterol. They are sold at all health food stores and
many supermarkets, and they make great sandwiches. You can find them next to
the vegetarian hot dogs, which are also great choices. As always, choose lower-
fat brands.
Veggie burgers are easy to make, and commercial brands are widely sold in
stores and restaurants. Try a few different brands, and find your favorites. Favor
those that are lowest in fat.
A BLT made with veggie bacon, lettuce, tomato, and mustard is a great
choice. My own keep-it-simple sandwich is a CLT, made on toasted rye bread
with lettuce, sliced cucumber and tomato, sometimes a vegan deli slice or two,
and topped with Dijon mustard.
Speaking of condiments, mustard is fat-free; make it your spread of choice.
Most mayonnaise spreads are just the opposite—they are loaded with fat. There
are now many vegan mayos on the market, but they are not necessarily low in
fat. Check the labels.
Frozen meals. The TV dinner has grown up. The amazing variety of frozen
foods, plus the convenience of microwave ovens, makes it easy to eat healthful,
tasty foods. Some favorites include vegan enchilada or burrito dinners and pizza
or pasta dishes.
If lunch means dining out—or perhaps fast food—see Chapter 8 for healthful
restaurant choices.
Healthful Dinner Ideas
There is a limitless array of healthful foods for dinner, whether you like to cook
or not. Many people enjoy cooking, but many others feel too busy or just cannot
be bothered; they tend to choose simple and convenient foods or eat out.
Personally, I fall squarely into the second group.
The good news is that both temperaments do very well in this program. Here
are a few ideas for starters.
Pasta marinara: Many commercial sauces are fine. Choose those lowest in fat
and free of cheese and other animal products. Add some mushrooms,
artichoke hearts, or broccoli or spinach (prepared fresh or frozen), and you
will be set.
Beans and rice: Try Cuban black beans with salsa, vegetarian baked beans, or
“refried” beans.
Soft tacos: Start with a whole wheat tortilla and add beans, lettuce, tomato,
and salsa.
Chili: Vegetarian boxed versions are fine.
Veggie lasagna: Use low-fat tofu to replace the ricotta, and add layers of
grilled veggies.
Rice pilaf, Spanish rice, or packaged rice dinners: Many commercial brands
are fine, but omit the butter.
Fried rice and vegetables: Use a nonstick pan and season this meal with low-
sodium soy sauce.
Fat-free veggie burgers: Read the labels and choose those lowest in fat and
free of cheese and other animal products.
Fajitas: Lightly sauté sliced bell peppers, onion, and eggplant in a nonstick
pan and add fajita seasonings.
Stew made with chunky vegetables in a savory sauce
Mushroom stroganoff
Our job for now is not to make you into a chef, but simply to make a realistic
1-day menu of foods you really will eat and enjoy.
It pays to think “international.” many cuisines from around the world have
great choices, whether you make them yourself, have them at restaurants, or buy
them frozen: Mexican bean burritos, Italian pastas and bean soups, Chinese
vegetable and rice dishes, Japanese vegetable sushi with miso soup and salads,
Indian curries, Thai dishes, Ethiopian cuisine, and many others. These foods take
advantage of the rich tradition of plant-based diets in many countries.
If your idea of dinner is sending out for pizza, it can still be vegan and low in
fat. Just ask for all-vegetable toppings, such as mushrooms, peppers, onions,
sun-dried tomatoes, and capers. Hold the cheese and ask for extra tomato sauce
instead. If you are making pizza at home, you can add veggie pepperoni or other
deli slices if you like. For a cheesy taste, sprinkle on some nutritional yeast.
A Balanced Dinner
A good way to make sure your dinner is well balanced is to fill about a quarter of your plate with
a legume dish. That means beans, peas, or lentils. So you might choose baked beans, a bean
burrito, or black-eyed peas, for example. These foods are rich in protein, soluble fiber, and
minerals and have wonderfully low GIs.
Next, fill another quarter of your plate with a starchy food such as brown rice, a yam, or
pasta. Starch is an unglamorous word, but it really means complex carbohydrate—the healthy,
clean-burning fuel that powers your body.
Finally, fill the remaining half of your plate with vegetables. Ideally, choose two different
varieties—say, a green vegetable like broccoli and an orange vegetable like carrots. These
foods are your nutrition powerhouses. Add fruit for dessert, and you will be set.
You can vary these proportions if you like. As long as your plate is vegan, low fat, and low
GI, you will be fine.
There are a million ways to do this. Some people like an Italian or Mediterranean meal,
which might include bean soup and pasta with a chunky vegetable sauce. Others prefer Latin
American meals, with beans, rice, and vegetables. Some might favor an Asian dinner, with tofu
(which counts as a legume because it is made from soybeans), rice, and vegetables. An Indian-
inspired plate might include a lentil curry with rice and vegetables.
For Americans from Southern states, many traditional foods fit the bill beautifully: beans or
black-eyed peas, rice, and greens (without the traditional fatback).
When my North Dakota parents decided to improve their own way of eating, we substituted
a bean dish and vegetable cutlets for the usual meat dish and added yams or sweet potatoes,
along with a couple of vegetable choices. Dessert was pears, strawberries, or oranges. See the
pattern? It’s still there: a bean dish, a starchy food for healthy carbs, vegetables, and fruit for
dessert.
Simple Snack Ideas
okay, your day’s menu is nearly complete. But even if you feel you will not be
hungry between meals, pencil in a few snack ideas so you will be ready in case
the munchies do hit. A 3:00 p.m. Hunger pang can erode your resolve, so stock
up on things that you can feel good about eating. Here are some snack
suggestions.
Fruits have a surprisingly low GI in most cases, and they are unbeatable for
nutritional value. Keep apples, oranges, pears, bananas, and other fruits on hand.
Some people like to keep a bowl of cantaloupe and melon chunks in the
refrigerator for an instant snack that’s ready when they get home. Don’t forget
tropical favorites, like mangoes and papayas. Dried fruits are acceptable.
Surprisingly, their GIs are not necessarily higher than those of fresh fruit.
Because their water has been removed, however, it is easy to take in far more
calories with dried fruit than with fresh fruit, so it pays to favor the fresh
varieties.
Instant soups are great to keep in your desk drawer; just add hot water when
you are ready to eat. Minestrone, split pea, lentil, and other varieties are typically
vegan and low in fat.
A simple CLT—the sandwich of lettuce and sliced cucumber and tomato
with mustard on rye bread I mentioned above—will fill you up, with nothing to
regret.
Three-bean salad will hold you until dinner.
Air-popped popcorn skips the fat of the usual kind. Top it with garlic salt,
mixed seasonings (e.g., Spike), or nutritional yeast.
Hummus on a whole wheat pita is filling and low in fat if you make it
without added oil.
Other simple snacks include bran cereal with soy milk, pumpernickel or rye
toast with jam, carrot sticks, and rice cakes (look for simple, unsugared
varieties).
STEP 2: A 3-WEEK TEST DRIVE
All right, you are doing great! You have made good choices that will give you a
healthy start. Now, let’s take a 3-week period and, during that time, let’s make it
all vegan all the time. That means no animal products at all, keep the oils low,
and favor healthy, low-GI foods. At this point, that will be easy, because you
picked out the foods you like during week one. No need to whip up something
new every day. It is fine to repeat items, use leftovers, or make your life easy in
any way you can. Remember, though, do not limit calories or skip meals.
It is essential to be realistic. If you do not enjoy cooking now, that is unlikely
to change. Plan to have foods on hand that require little preparation.
Will you be at work? Traveling? Planning ahead is essential. If there is
nothing healthful in the company canteen, you will want to pack a lunch.
Sometimes when a colleague asks what I am having for lunch, I answer, les
restes d’hier. This sounds exotic until I explain that the phrase is actually
French for “leftovers.” But the fact is, my leftovers sometimes are exotic,
depending on which restaurant filled the doggie bag!
Let’s Go Shopping
It pays to stock your shelves with the foods and ingredients you will need so
your 3-week test drive goes smoothly. And when hunger hits, you will be ready.
Take a trip down those aisles at the supermarket that you may well have
neglected in the past. The produce department may stock meat substitutes, soy
milk, and other healthy products, along with an ever-growing array of new and
interesting fruits and vegetables. Also check out the “international,” “health,”
and “dietetic” aisles. And look at the shelves with innumerable varieties of rice
and colorful dried beans.
Be sure to check out your nearest health food store if you have not done so
already. You will find substitutes for meat and milk and interesting foods from
other countries, all worth a try. Explore and experiment; some new finds will
become favorites. If the occasional purchase turns out to be a dud, do not worry.
That is what experimenting is all about.
As you shop, pick up ingredients that will allow you to prepare a few extra
things on the weekend—a pot of soup or stew, for example—that you can then
split into portions for quick reheating during the week.
You will notice that prices for healthful foods vary widely. Overall, plant-
based foods are less expensive than meaty or cheesy products. Beans, fresh and
frozen vegetables, pasta, rice—these humble ingredients cost very little.
However, health food stores sometimes put premium prices on prepared
products, which is true for nonvegetarian as well as healthful vegan items. You
will soon sort out your best choices.
While you are at the store, pick up a vitamin B
12
supplement, and if you do
not get regular sunshine, purchase a vitamin D supplement, too.
Some Staples: Basic Foods to Taste and Try
There are a few basic foods that would be good for you to get to know. They are
not elaborate—just simple, basic staples that ought to be on your shelves. If they
are new to you, they will be healthful additions to your repertoire. Let me list
some here and encourage you to think about them when shopping.
Old-fashioned oatmeal. Choose this variety rather than instant, and see how
easy and fast it is to make. Just combine 1 part oatmeal with 2 parts cold water,
bring to a boil, and simmer for a few minutes. That’s all there is to it. Oatmeal is
loaded with soluble fiber to bring your cholesterol down and filling enough to
keep hunger at bay all morning. While you are at the store, pick up some
toppings: cinnamon, raisins or other fruit, or whatever calls to you.
Beans. Get to know the many varieties of this humble food. Very low in fat;
devoid of cholesterol; high in soluble fiber, calcium, and iron; and with an
enviable glycemic index, beans’ day has arrived. Cook them up from scratch if
you like, but it’s handy to stock your shelves with a couple of cans of black
beans (and a jar of salsa), fat-free “refried” beans, and any other varieties you
see.
Frozen vegetables. Convenience is the word here. If you are the slightest bit
pressed for time, you will be glad you have vegetables in your freezer that just
need a little steaming. Nutritionally, frozen vegetables are equivalent to fresh.
Look for broccoli, winter squash, petite Brussels sprouts, carrots, cauliflower,
and anything else you fancy.
Lentil soup. Lentils assert themselves in a hearty and healthful soup. Keep a
can or two on hand.
Hummus. As I mentioned above, this simple chickpea dip has become an
enormously popular sandwich filling. But skip the commercial brands, which are
too high in fat. If you have a food processor, you can make your own in less than
5 minutes, and you will be set for the week.
Chickpeas. Speaking of chickpeas, this is one legume that is really at home
just about anywhere—not just as hummus but also in salads, soups, pasta sauces,
and stir-fries. You can even eat them for breakfast. Keep a few cans on your
shelf; the extra-small cans with pop-top lids are especially convenient.
Toppings. Dijon mustard is great for sandwiches, and lemon juice or apple
cider vinegar is great on green vegetables and salads. Salsa was just made for
beans, and fat-free dressings of any variety are handy, too.
Brown rice. Most people have never tasted a properly prepared bowl of rice.
The trick is to select brown rice, toast it slightly, and cook it like pasta, using
what may seem like too much water and draining away the excess at the end.
Barley. This grain is all over the breakfast cereal aisle, in puffed and sugared
form, but barley really shines in soups or when served as a grain side dish. You
can mix it with rice and cook them together. Barley has a low GI, lots of soluble
fiber, and wonderful taste and texture.
Spaghetti sauce. Take a few minutes to read labels on jars of marinara sauce
to find varieties that exclude cheese and other animal products and keep oil to a
minimum. Then stock your shelves for a quick and easy dinner. Pick up your
favorite pasta to go with it.
Meat substitutes. Try the veggie versions of hot dogs, burgers, and deli
slices. They are not haute cuisine, but they serve a useful purpose, and some
taste surprisingly similar to the foods they imitate. Read the labels, though, and
skip products with animal-derived ingredients or more than 2 to 3 grams of fat
per serving. Health food stores have a huge selection, and many regular
supermarkets carry them, too.
Nutritional yeast. You can find this in the supplement aisle at health food
stores. Nutritional yeast dissolves into spaghetti sauces, stir-fries, casseroles,
soups, and lots of other recipes, adding a subtle cheese-like taste. It is not the
same as brewers yeast or bakers yeast, both of which taste bitter. Nutritional
yeast comes in flakes and powder. For better texture and versatility, buy the
flakes.
Fresh fruit. Fresh fruit is a perfect snack, and you will want to keep it on
hand. Buy extra for friends and family.
Check the Label
There are two things you want to look for on product labels. First, check the ingredients list to
make sure there are no animal-derived ingredients. Common ones include milk solids, whey,
casein (and various casein derivatives, such as sodium caseinate), egg products, and gelatin.
Also be on the lookout for partially hydrogenated vegetable oils, which are as bad as saturated
fat.
Sometimes people want to make exceptions for foods that sound as if they are healthful.
Honey, for example, has gotten unjustified good press over the decades. Nutritionally speaking,
it is simply sugar, offering you nothing from a health standpoint. Rather like olive oil, its
marketing has gotten way ahead of its value.
Next, check the Nutrition Facts. Ideally, a serving of food will have no more than about 3
grams of fat and should have zero cholesterol. If the cholesterol content is anything other than
zero, the product contains some animal-derived ingredient. If label reading seems a bit
cumbersome, keep in mind that you need to check a product only once. As you find the
products that fit the bill, there’s no need to check them again. Also, simple foods do not need
labels. No one ever had to look for the fine print on a banana or pear, a box of frozen spinach,
or a bag of navy beans. Each of these foods has exactly one ingredient.
What to Do with Unhealthy Foods?
So you have filled your shelves and refrigerator with healthy staples. If some
not-so-healthful items from your previous diet are still lurking, though, what do
you do? That’s easy: get rid of them. Do not “use them up” because they will
continue to cause problems for you. Toss them. And if family members or
roommates share your kitchen space, avoid keeping tempting foods too near
your own. They will present more of a temptation than you need.
Planning Ahead
Eventually, healthful eating will become second nature. For now, though, you
will need to put a bit of thought into where you will be at lunchtime and
dinnertime and what you will have. There really are healthy choices out there,
but they are sometimes not so obvious in a culture that caters to unhealthy tastes.
It helps to plan ahead.
ON YOUR MARK, GET SET…
As we’ve discussed, you will want to pick out a 3-week period and really dive
into this new menu. Choose a time when you have the mental energy to embrace
a change. If you are an accountant, April 14 probably is not a good time. If you
are a student, exam week may not be the best choice. But once you have picked
your time, jump in with both feet. Do the diet change 100 percent. Follow our
three guidelines as closely as humanly possible, and do it all the way.
Okay, you have done great. You have the basics down. In the next several
chapters, we will look at specific health issues and situations you may encounter,
and I will offer plenty of tips for handling them.
CHAPTER 6
Healthful Weight Control
If you have been aiming to lose weight, let me show you the steps that make the
process as easy, effective, and permanent as possible. Eliminating unwanted
pounds is important for anyone—but especially for people with diabetes. For
starters, it boosts your insulin sensitivity; the more body fat you trim away, the
more responsive your cells are to whatever insulin your pancreas is producing.
Weight loss also brings down your cholesterol and blood pressure. And when
you’ve trimmed away body fat, exercise is that much easier and more inviting.
Your joints—especially your knees—will thank you.
Needless to say, there are a great many ways to lose weight. Cutting calories
works for some people, but others find it a real challenge. If you normally eat
2,000 calories per day, for example, a common recommendation would limit you
to 1,500—and that gets old very fast. If you’re hungry at 8:00 in the evening and
you’ve already had your 1,500 calories for the day, you will go to bed hungry.
That will never happen on the program recommended in this book.
A healthy approach to weight loss focuses on choosing the right kinds of
foods, not on the quantity of food you eat. When you have the right foods on
your side, the calories and portions fall into line on their own, and weight loss is
almost automatic.
A WEIGHT-LOSS DIET THAT WORKS
In 2005, my research team published the results of an important study that tested
a new and powerful approach to weight loss. The participants were women with
moderate to severe weight problems. Most had tried many different diets: low-
calorie diets, low-carb diets, Weight Watchers, the cabbage-soup diet, and just
about everything else. Like most people, they had found these diets tough to
follow, and whatever weight they lost soon returned.
Our approach was very different. It did not include calorie counting, limits
on portions or carbohydrates, or even an exercise prescription. For research
purposes, we wanted to isolate the effects of diet.
The participants lost weight easily, averaging about 1 pound per week—
week after week after week—and they kept it off long-term.
1
Other researchers
have found much the same thing.
Why is a plant-based diet so powerful for weight control? Well, first of all, it
is important to understand where the calories are hiding in the foods you eat. A
chicken stores extra calories in chicken fat. A cow stores calories in beef fat. A
fish stores them in fish fat. Body fat—in humans or animals—is a calorie-
storage system.
If you were to remove a bit of fat from a drumstick or chicken wing and send
it to a laboratory, you would find that a gram of fat—that’s
1
28
ounce—has 9
calories. That is a lot. It is more than double the calories in a gram of
carbohydrate—the starch in rice, beans, or sweet potatoes, for example.
Carbohydrates have only 4 calories per gram. Small wonder that people who
make rice or other plant foods their staples tend to stay slim. Throughout Asia
and rural Africa, rice and other grains, root vegetables, and various legumes are
the traditional foundation of the diet. These foods are filling but have relatively
few calories.
Of course, it’s a different story in North America and Europe, where meals
feature meat and dairy products, which contain the very fat that animals have
used to store their excess calories. Weight problems are the all-too-common
result. If you want to avoid taking in extra calories, you would do well to avoid
eating the concentrated calories that animals have hidden away in their body fat.
So, step one is to avoid animal products. If you do that, you will of course
avoid animal fat completely.
Step two is to keep vegetable oils to a minimum. Beans, grains, vegetables,
fruits, and most other foods from plants have very little fat. There are a few
exceptions, however: nuts, seeds, avocados, and some soy products are high in
fat. Keep them to a minimum as well.
Be especially careful about vegetable oils used in cooking or in salad
dressings. Now, some people argue that plant oils are more healthful than animal
fats, and it’s true that they are much lower in saturated fat, the kind that raises
cholesterol levels and is linked to breast cancer and insulin resistance. When it
comes to weight problems, however, animal fats and vegetable oils are
essentially all the same. They all pack in 9 calories per gram.
Step three is to focus on high-fiber foods. A grain of brown rice, for
example, has a thin cloak of fiber that gives the rice its tan color. To produce
white rice, manufacturers strip away this coating, but you are better off if it is
left intact. Fiber fills you up so you feel naturally satisfied with fewer calories.
As you saw in Chapter 4, every 14 grams of fiber added to your daily menu
cuts calorie intake by about 10 percent on average.
2
That simply means that
high-fiber foods fill you up faster, so you stop eating sooner. Instead of trying by
sheer force of willpower to cut calories, you cut them without even thinking
about it.
The richest sources of fiber are beans, vegetables, fruits, and whole grains.
While breakfast cereal commercials tend to push grains as the best fiber source,
you will find much more fiber in beans and most vegetables than in most grains.
But they all add up. Aim for at least 40 grams per day. One caveat: If high-fiber
foods, especially beans, have not been part of your routine, you’ll want to
increase the amount you eat gradually to give your digestive tract time to adjust.
See Chapter 9 for more tips on avoiding digestive problems.
In the next chapter, I will show you an easy way to check your fiber intake
using the Quick Fiber Check.
Okay, let’s summarize: To lose weight, you want to avoid animal products,
limit the use of vegetable oils, and go high fiber. Vegetables, fruits, whole grains,
and beans fit the bill perfectly.
Steps to Weight Loss
1. Avoid animal products. If you steer clear of fish, chicken, beef, dairy foods, and all other
animal products, you will cut your animal fat intake to zero. What’s more, this shift will mean
that you will naturally eat high-fiber foods to replace those from animal sources, which have
no fiber.
2. Keep vegetable oils to a minimum. If you have a bottle of cooking oil in your kitchen, throw it
away. There are simpler and better ways to cook. Also limit nuts, seeds, avocados, and full-
fat soy products.
3. Favor high-fiber foods. Build your meals from beans and other legumes, vegetables, fruits,
and whole grains.
To ensure complete nutrition, be sure to have a vitamin B
12
supplement each day.
HEALTHY EXAMPLES
By now, you already have a good idea of what this looks like on your plate,
because the diet changes for weight loss are very much like those for controlling
your blood sugar. Breakfast might start with veggie sausage or veggie bacon—
that is, faux meats made of soy or wheat—followed by a big bowl of oatmeal or
perhaps some fresh fruit. You would skip bacon, eggs, and ordinary bagels,
which are stripped of fiber.
Lunch could be a sandwich made with sliced tomato, lettuce, and veggie deli
slices on rye, or a pasta salad would be fine, too.
For dinner, you might try tomato or split pea soup followed by a vegetable
stir-fry or shepherd’s pie filled with chunky vegetables. In the process, you will
avoid animal fat, have very little vegetable oil, and get all the fiber in those
healthy vegetables.
For a between-meal snack, an apple or banana fits the bill nicely, while
potato chips or nuts pack too much fat.
Vance
When Vance joined our study, he wanted to get his weight down to 210 to 225
pounds. Since he initially weighed in at 276 pounds, he had a ways to go. He
stuck to the diet program, however, not worrying about calories or portions but
paying close attention to the types of food he chose. Everything was vegan and
low in fat. Also, in order to give the diet a good test, he agreed not to add any
exercise for the first 6 months.
The pounds started to come off. Three months later, he weighed in at 251—a
loss of 25 pounds in about 12 weeks. Friends couldn’t help but notice, and many
asked him what his secret was. After 6 months, he was down to 238. At the 14-
month mark, he was at 217.
Nancy
Nancy began the study at 197 pounds. Like Vance, she changed her diet but kept
her activity level the same to allow us to test what the diet change alone could
do. Three months into the program, her weight was down by 14 pounds. After 6
months, she had lost 25 pounds, and at 14 months, she weighed 155 pounds—a
loss of 42 pounds without counting calories.
Not Exactly Health Food
A few years ago, I was running a study on diet and weight loss and found that a couple of our
participants were chowing down on Twizzlers—the red candy that comes in long twists like
licorice. When I asked why they were eating candy, they pointed out that the product is both
vegan and low in fat. And sure enough, there’s a friendly message printed on a package of
Twizzlers Strawberry Twists:
Did you know…
Strawberry Twists are a low-fat candy! That’s right, the same great-tasting
Twizzlers you have known and loved are low in fat, as always. Nothing has changed.
A look at the ingredients list shows that, indeed, nothing has changed. Like other candies, it
is basically a sugary concoction containing nothing that your body even remotely needs. Sugar
is nowhere near as high in calories as fat, but it still provides more calories than you need.
FOODS THAT WORK MAGIC
These simple foods have surprising effects. Not only do they help you trim
hundreds of calories off your daily menu, they also cause a fundamental change
within the cells of your body. As you saw in Chapter 2, clinical tests have shown
that they increase your body’s after-meal calorie burn. The reason is this: As you
change your diet, your insulin sensitivity begins to improve. That means that
glucose has an easier time entering your cells to be burned for energy, rather than
continuing to circulate in your blood.
3
The after-meal calorie burn is small, but it
lasts for 3 or more hours after each meal, giving you an extra edge for losing
weight.
APPETITE CONTROL
Barbara Rolls, PhD, a researcher at Pennsylvania State University, has proposed
an innovative way of thinking about appetite control based on a concept called
energy density.
4
Her studies have looked at what triggers satiety—the sense of
fullness after meals—and shown how to plan meals to bring on a feeling of
satiety earlier.
Surprisingly, what makes us stop eating does not seem to be the number of
calories we have ingested, nor is it the amount of carbohydrate or protein in a
meal. Rather, it is the weight of food we have taken in. It is as if your stomach
has a scale, and once it registers a certain number of grams of food, it signals
your brain that you have had enough.
We all tend to eat roughly the same weight of food each day. If your meals
do not add up as they normally do, your appetite guides you to have a little more.
There’s an effective weight-loss strategy in there. If the foods you eat contain
a fair amount of water—soups or fruit, for example—they are heavy enough to
tip your “stomach scale” and reduce your appetite. Because the weight of these
foods comes mainly from water, which has no calories, they tend to cut your
total calorie intake for the day. These foods have a low energy density. That is,
they have relatively few calories, even though they might have enough weight to
convince your stomach that you’ve eaten quite a lot.
One important caveat: For some reason, simply drinking water will not turn
off your appetite. Your stomach apparently reacts differently to heavy foods—
which trigger an appetite shutoff—than to a drink of water, which does not.
Dr. Rolls proved this with an interesting lunchtime experiment. When
research volunteers ate a casserole appetizer along with a glass of water, they ate
about 400 calories at lunch. In a separate test, however, she stirred the glassful of
water into the casserole to make soup. When she measured the participants’
calorie intake afterward, she found it was cut to less than 300. The soup tricked
their stomachs into shutting off their appetites.
Here are some tips for reducing the energy density of your meals.
Soups are a great choice. They are filling but generally low in calories. Favor
clear, low-sodium soups rather than creamy varieties.
Add tomatoes, chickpeas, cucumbers, peppers, and other vegetables to turn a
salad into a meal while keeping it low in calories. Use fat-free dressing,
lemon juice, or apple cider vinegar rather than regular oily dressings.
Apples, oranges, pears, mangoes, papayas, berries, and most other fruits are
excellent choices for snacks, desserts, or a meal.
Vegetables of virtually any variety are good choices. Adding chunky
vegetables to salads and casseroles reduces their energy density in a very
helpful way.
Bean dishes are filling, but surprisingly modest in calories if they are made
without added fat. Think of chili and casseroles.
Go for whole grains. Rice beats rice cakes. Pasta beats bread. In each case,
one is water-based and filling, while the other is airy and not filling at all.
Old-fashioned oatmeal is a great breakfast choice.
Including these foods generously in your menu will accelerate your weight
loss. There’s an easy way to check the energy density of commercial food
products: Just take a look at the label. If one serving has fewer calories than
grams, it is a good choice. For example, the label on a can of black beans
(below) shows that a serving has 90 calories and weighs 122 grams, so the beans
are a good choice.
Black Beans
Nutrition Facts
Serving Size ½ cup (122 g)
Servings Per Container Approx 3½
Amount Per Serving: Calories 90, Calories from Fat 5
A can of spinach has 30 calories and 115 grams per serving, so it’s also a
winner. Each of these foods has less than 1 calorie per gram, so the weight of the
food fills you up before the calories fill you out.
What about skinless chicken breast? One serving has 173 calories and
weighs about 100 grams (3.5 ounces). Not a good choice. Aside from not being
vegan or particularly low in fat (23 percent of calories), it has far more calories
than grams.
A slice of bread may have 80 calories and weigh 32 grams. It has few
calories but is very lightweight, so it is not filling. With more calories than
grams, it is not especially helpful for weight loss.
I am not suggesting that you use energy density in place of the other diet
guidelines in this book. Use it in addition to this program to ramp up the weight-
loss power of your new menu. It will help you pick from among the allowed
foods those that are the most filling with the fewest calories.
Again, the idea is simply to reduce the energy density of the foods you eat by
choosing those that naturally contain a fair amount of water to fill you up and
shut off your appetite.
STEER CLEAR OF LOW-CARB DIETS
Low-carbohydrate diets are popular, on and off. But they are potential disasters
for anyone, especially for people with diabetes. They often bring short-term
weight loss, but most of the weight quickly returns. Low-carb diets also have
wildly unpredictable health effects. In research studies, as many as one-third of
low-carb dieters have shown a significant increase in LDL (“bad”) cholesterol.
Some have had such high cholesterol levels that they have been forced to drop
out of studies.
What’s more, low-carb diets are usually high in protein. The animal protein
that is commonly emphasized in these diets can be hard on your kidneys.
Harvard researchers tracked kidney function in 1,624 women participating in the
Nurses’ Health Study, focusing especially on those who had any loss of kidney
function at the start of the study. It turned out that the more animal protein the
women consumed, the more kidney function they lost.
8
Given that about 40
percent of people with diabetes have already lost some kidney function, it makes
good sense to protect yourself against further damage.
9
I strongly caution against
any diets that recommend high-protein foods.
As you have seen, such diets are based on the outdated idea that avoiding
carbohydrates is the key to glucose control. As you know by now, populations
that make rice, noodles, and other carbohydrate-rich foods their diet staples
actually have had very little obesity and very little diabetes.
Sometimes, when people blame “carbs” for their weight problems, they are
thinking of cookies and cupcakes. But if you have ever looked at recipes for
these products, you know that an enormous load of fat—typically from butter or
shortening—is usually lurking inside. So the carbohydrate in these products is
really an innocent bystander; it’s their load of fat that can fatten you up.
If you are stuck in the “carbs are fattening” mentality, let me share the results
of an important study. National Institutes of Health researchers asked 19
overweight volunteers to follow a rigorously controlled low-carb diet and a low-
fat diet at separate times—all the while under the watchful eyes of the NIH
Metabolic Clinical Research Unit, where they lived throughout the experiment.
Both diets had precisely the same number of calories; the difference was simply
that one was low in fat and the other was low-carb. But the results were clear.
The low-fat diet trimmed away roughly twice as much body fat, compared with
the low-carb diet.
10
Low-carb diets can cause weight loss over the short run, but there are far
healthier ways to achieve that goal and to make weight loss last over the long
run.
Low-Carb Diets Can Worsen Cholesterol Levels
Weight loss lowers cholesterol levels. On average, each pound you lose lowers your
cholesterol level about 1 point (that is, 1 mg/dl or 0.3 mmol/l),
5
so most weight-loss diets have
a side benefit of improving your cholesterol test results. The exception is low-carbohydrate
diets. They are so high in fat and cholesterol that they increase cholesterol levels for about one
in every three dieters, some of whom have eventually experienced wildly high cholesterol levels
and serious heart disease symptoms.
6,
7
There is no good reason to begin any low-
carbohydrate, high-protein diet.
WHAT TO EXPECT
Everyone loses weight at his or her own pace. In our studies using low-fat vegan
diets, weight loss averages about 1 pound per week. Adding exercise can
increase your weight loss depending on your regimen.
You may find that you lose weight, then reach a plateau and stay there for a
while. If that happens, see if there is something in your diet you can change,
such as eliminating hidden sources of oil or boosting your fiber intake, or
bringing in the low-energy-density foods we discussed above. Our bodies seem
to have different plateaus depending on the fat content of our foods. That is to
say, if you drop the fat content slightly, your weight will probably drop a bit,
then plateau. If you drop the fat content more, you’ll drop down to a new
plateau.
The same thing works with fiber. Do a Quick Fiber Check, and if you’re not
up to 40 grams per day, try adding more beans, vegetables, fruits, and whole
grains to your diet. You’ll find that the combination of steering clear of fats and
bringing in fiber helps trim away the pounds.
Take Your Time
If you have gradually gained weight over the years, let it come off gradually.
Don’t starve yourself in the hope of instant results. If you are on an optimal diet
and are physically active, nature will take its course. As the weeks go by, you
will not only be slimmer, you will also be healthier. Your cholesterol and blood
pressure are likely to fall along with your blood glucose. As always, stay in close
touch with your doctor so your medication doses can be revised as you regain
your health.
CHAPTER 7
How to Test Yourself and Track Your
Progress
In this chapter, we will look at the various tests that allow you to track your
progress. The first one, glucose testing, is particularly important, but please read
through the whole chapter. It will help you stay on the right path. We will start
with blood tests and then look at other kinds of testing, including weight, blood
pressure, and examinations of the eyes and feet.
GLUCOSE TESTING
Monitoring your blood sugar is important for controlling diabetes. Glucose is
measured in milligrams per deciliter (mg/dl) in the United States and in
millimoles per liter (mmol/l) in most of the rest of the world.
If you have type 1 diabetes or are using insulin for type 2 or gestational
diabetes, you should check your glucose at least three times a day or according
to whatever schedule your doctor recommends. If you have type 2 diabetes and
are using oral medications, there is no optimal testing frequency. As a rule of
thumb, however, when your diet, medications, exercise routine, or health status
changes, it is important to test more frequently. If your doctor is not yet aware
that you are about to make a change, now is the time to share that information.
You should also discuss what to do if your blood glucose is too high or too low.
As you begin a healthful diet, your numbers are likely to fall significantly.
Regular glucose testing is especially important if you are taking diabetes
medications, particularly insulin or medications that cause your body to release
insulin. The reason is that these are powerful drugs that actively push your blood
sugar down. And you are now starting a powerful new diet. The combination of
these treatments—drugs and diet (sometimes along with exercise)—may end up
pushing your blood sugar too low.
I know what you may be thinking: Impossible! If all you have ever heard
from your doctor is that your blood sugar is too high, it’s hard to imagine it
could fall too low. Well, it can. The combination of a powerful diet and the
diabetes medications you may already be on can be very strong. In fact, your
blood glucose can fall so low that you start to shake and sweat (see below for
other symptoms). This is called hypoglycemia. In rare cases, people who make a
major diet change or embrace a strenuous exercise program without backing off
on medications find their blood sugar drops dangerously low—so low that they
can lose consciousness. This is why it is essential that your doctor be made
aware of the changes you are making—so your medication dosages can be
altered if your blood glucose takes a nosedive.
Dangerous hypoglycemia is very unlikely if you are on no medications, and
it is also unlikely if you are being treated with only metformin (Glucophage) or a
thiazolidinedione, such as pioglitazone (Actos) or rosiglitazone (Avandia).
However, hypoglycemia is likely to occur if you take any of the following drugs.
Insulin (injected or pump)
Glyburide (Micronase, Glynase, DiaBeta, or the combination drug
Glucovance)
Glipizide (Glucotrol)
Glimepiride (Amaryl)
Nateglinide (Starlix)
Repaglinide (Prandin)
This is just a short list of medications that may put you at risk. Ask your
doctor if the medications you are taking may cause hypoglycemia.
Although hypoglycemia is a sign that your body is regaining its insulin
sensitivity—which is of course a good thing—it is also a sign that your
medicines are now too strong and that you need to speak with your physician
right away about adjusting your medication regimen. If your doctor has stopped
your medications, hypoglycemia is very unlikely to occur.
Symptoms of hypoglycemia include:
Shaking
Sweating
Hunger
Anxiety
Weakness
Rapid heartbeat
Dizziness or lightheadedness
Sleepiness or confusion
Difficulty speaking
If you experience these symptoms, check your blood sugar. If it is below 70
mg/dl (3.9 mmol/l) or whatever other benchmark value your doctor
recommends, you need to eat something that raises your blood sugar quickly. If
you notice symptoms while driving, pull over to a safe spot. And if you are
unable to test your blood sugar or are unsure whether it is low, assume that it is
low and have something to eat. Glucose tablets are a great choice. They are sold
at all drugstores, and you will want to keep them in your purse or briefcase and
in your glove compartment. If your blood sugar check shows you are
hypoglycemic, you should take 15 grams of glucose. If you have typical glucose
tablets with 4 grams of glucose each, you will need to take four tablets at once.
Here are some other good choices.
½ cup (4 ounces) of any fruit juice
½ cup (4 ounces) of a regular (not diet) soft drink
5 or 6 pieces of hard candy
1 or 2 teaspoons of sugar
After 15 minutes, check your glucose again. If it is still below 70 mg/dl (3.9
mmol/l), have another serving, then check again in another 15 minutes. If you
are within an hour of mealtime, go ahead and eat. If not, have a snack. Be sure to
carry glucose tablets or a quick-energy food with you for emergencies, wear a
medical identification bracelet, and be especially attentive to your glucose level
during exercise, which can cause blood sugar to drop.
Hypoglycemia can also occur while you are asleep. Look for these signs.
Nightmares or crying out
Finding that your pajamas or sheets are damp from perspiration
Awakening with unusual tiredness, confusion, or irritability
Carl’s Hypoglycemic Episode
Carl had been taking metformin and glipizide for about 5 years, and his morning blood glucose
values ranged between 120 and 150 mg/dl (6.7 and 8.3 mmol/l). He changed his diet with the
hope of coming off his medications, and in fact, very soon after he began this program, his
readings began to drop. After about 2 weeks, they were often under 100 mg/dl (5.6 mmol/l).
Carl was delighted with such clear evidence that the changes were working.
About a month into the diet, he had an unusual experience. One morning at about 10:00
a.m., he found himself feeling unusually hungry. He always had a good appetite, but this was
something different. He felt ravenous. Over the next several minutes, he started to tremble and
broke into a sweat. “Oh, yes,” he thought to himself. “This is what they told me might happen.”
He checked his blood glucose, and it was 65 mg/dl (3.6 mmol/l), which is lower than it should
be. He had some orange juice and an early lunch. He telephoned his doctor, who reduced his
glipizide dosage. Over the next several weeks, the episodes repeated several times.
Eventually, his doctor stopped the glipizide altogether.
Carl’s morning blood glucose readings stabilized at around 80 to 90 mg/dl (4.4 to 5.0
mmol/l). He never needed to go back on glipizide, and he never had another hypoglycemic
episode.
If these occur, you can check for nighttime hypoglycemia. Simply set your
alarm for about 2:00 or 3:00 a.m. and check your blood sugar a few nights in a
row. Consult your doctor to see if you need a medication change.
Hypoglycemia does not mean there is anything wrong with your diet. Rather,
it means that the medication regimen you are on has become too strong for you.
The next step is to contact your physician or other caregiver, who will probably
reduce your medication dosages or eliminate one or more drugs. Get in touch
with your doctor as soon as possible—the same day the episode occurs. Do not
put it off, because the hypoglycemic episodes are likely to recur until your
medications are reduced.
To track your blood sugar, use a logbook or a simple grid like the one below.
Blood Glucose
DATE MEDICATION REGIMEN EARLY BREAKFAST LUNCH DINNER LATE
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
Note: It is especially helpful to check your blood glucose before meals. Mark these numbers to
the left of the slash marks. Mark after-meal values to the right of the slash marks.
MAKING SENSE OF GLUCOSE
Blood glucose values are a bit like the stock market: Although they generally
follow a trend, they can bounce around from day to day. Certain situations can
trigger an unexpected rise. Any sort of illness or infection can boost your blood
glucose; even a minor upper respiratory illness or a scraped foot can cause a
significant jump in your numbers. Stress can, too, due to the action of stress-
related hormones.
Having some up-and-down swings in blood sugar is normal, but if your
glucose remains high day after day, your risk of complications is higher than it
would be if your glucose level were better controlled. The American Diabetes
Association recommends that people with diabetes use the following guidelines
for blood glucose levels.
Fasting or before meals: 80 to 130 mg/dl (4.4 to 7.2 mmol/l)
One to 2 hours after a meal: below 180 mg/dl (10.0 mmol/l)
THE DAWN PHENOMENON AND THE SOMOGYI EFFECT
You may occasionally be surprised to find that your blood glucose is higher in
the morning than it was when you went to bed the night before. Or perhaps you
checked your glucose in the early morning and then went back to sleep, only to
find that it had risen while you slept. How is this possible?
No, sugarplums dancing in your head had nothing to do with it. The fact is,
your body constantly monitors the amount of glucose in your bloodstream and
adjusts it from time to time. Glucose is vital to your body’s functioning—
especially to the workings of your brain—so your body has a way of increasing
your blood glucose when it gets a bit low. In the early-morning hours—typically
between 5:00 and 9:00 a.m.—hormones (growth hormone, cortisol, and
catecholamines) cause your liver to release glucose into the bloodstream. These
hormones can also interfere with insulin’s efforts to remove glucose from the
blood. This “dawn phenomenon” can noticeably raise your blood sugar.
1
A similar reaction can occur when a person using long-acting insulin has an
unusual blood glucose dip in the middle of the night. Let’s say, for example, that
you miss your usual late-night snack, and the insulin you are taking forces your
glucose level too low. Once again, your natural hormones will compensate,
raising your blood sugar. This is called the Somogyi effect. It is different from
the dawn phenomenon in that it is triggered by an overly low blood sugar level
occurring in the middle of the night.
Although your body has a system for controlling your blood sugar, it is a bit
imprecise. Your blood sugar can still run too low or too high despite your body’s
best efforts, and you will occasionally see a high or low level that you cannot
explain.
HEMOGLOBIN A1C
As discussed in Chapter 1, the main test for assessing your progress is
hemoglobin A1C. Your A1C level should be checked every 6 months, or every 3
months if your diet, medications, or general health is changing or if previous
values have been too high. If your A1C is high, your doctor will be concerned,
and you should be, too. If it is low, you are doing well. To give you a frame of
reference, the American Diabetes Association says that most people with
diabetes should keep their A1C below 7 percent. A lower target, say 6.5 percent,
makes sense if you can get there without risking hypoglycemia (that is, if you
are not on medications that are likely to cause hypoglycemia). If you do tend to
have frequent hypoglycemic episodes, your caregiver may recommend a less
stringent target, say 8.0 percent, in order to keep your blood glucose from falling
too low.
A typical oral diabetes medication brings A1C down by an average of about
1 point or a bit less. The effect of a good diet on A1C varies depending on how
good your control is when you start, how well you follow the diet, and how
much excess weight you lose. Your result will also be affected by exercise,
genetics, and other factors.
The biggest drops we have seen in short-term research studies are around 4
points in approximately 6 months. These are seen in people whose A1Cs were
high (say, 9 or 10) to begin with. People whose A1Cs are in the 7 to 8 range are
likely to have a drop averaging between 1 and 2 points. People who continue to
lose weight beyond this time could have an even greater drop, assuming they
were not already in the normal range.
The higher your A1C, the greater your risk of circulatory problems.
Evidence suggests that keeping A1C low is particularly important for the health
of your eyes and kidneys and for preventing nerve symptoms.
From your heart’s standpoint, a 1-point increase on the A1C scale—from 7
to 8 or 8 to 9, for example—brings about a 20 percent increase in your risk of
heart problems over about a decade.
2
In other words, if you had a 10 percent risk
of having a heart attack sometime in the next decade, a 1-point rise in your A1C,
maintained over the whole decade, would boost your risk to 12 percent. A 2-
point rise would mean a 14 percent risk, and so on. What these numbers tell us is
that A1C is important and that by all means, you will want to aim to get your
A1C down. However, A1C is not the sole key to good health. To stop diabetes
from attacking your heart and blood vessels, you will also want to focus on your
blood pressure, cholesterol, and weight. Needless to say, your doctor can and
should track these values with you.
CHOLESTEROL
Your doctor will check your cholesterol at regular intervals, at least once a year.
As you will see in Chapter 12, high levels of cholesterol in the blood can damage
your heart, major blood vessels, and the delicate blood vessels of the eyes and
kidneys. Here are the numbers to aim for.
3
Total cholesterol. According to most authorities, total cholesterol should be
below 200 mg/dl (5.2 mmol/l). I suggest you aim for a considerably lower goal,
however. First of all, the average cholesterol level in the United States is
hovering around 200 mg/dl, and in a country where heart attacks are the cause of
death for half the population, you do not want to be anywhere near average! In
large population studies, it is clear that the lower your cholesterol, the lower your
risk of heart problems, until you reach a threshold of about 150 mg/dl (3.9
mmol/l). My suggestion is to use that as your goal rather than the more
permissive “official” figure.
Low-density lipoprotein (LDL) cholesterol. LDL cholesterol is often called
bad cholesterol because it raises your risk of heart problems and other blood
vessel complications. According to most authorities, your LDL should be below
100 mg/dl (2.6 mmol/l). Your risk of heart problems drops as LDL decreases,
until you reach a level of approximately 40 mg/dl (1.0 mmol/l).
4
High-density lipoprotein (HDL) cholesterol. HDL cholesterol is often
called good cholesterol because it carries cholesterol out of the body. Some
evidence suggests that the higher your HDL cholesterol, the better. Current goals
are to have an HDL level above 40 mg/dl (1.0 mmol/l) for men and above 50
mg/dl (1.34 mmol/l) for women.
Some doctors, however, interpret HDL in the context of your total
cholesterol concentration: In this case, a favorable HDL reading would be at
least one-third of your total cholesterol. For example, if your total cholesterol is
150, a healthy HDL would be 50 or above. This is an important consideration
because many people who follow healthful diets do not have much of any kind
of cholesterol—LDL, HDL, or anything else.
Recent evidence has called the importance of HDL into question. Although
lowering LDL cholesterol does reduce your risk of heart problems, raising HDL
does not seem to make any difference.
Triglycerides. Triglycerides are tiny fat particles transported in the
bloodstream. Normal triglyceride concentration is less than 150 mg/dl (1.7
mmol/l).
See Chapter 12 for information on controlling cholesterol and triglycerides.
TRACKING YOUR BLOOD PRESSURE
Maintaining healthy blood pressure is extremely important. As you can imagine,
increased pressure inside your arteries can damage the arteries themselves, as
well as your heart, eyes, kidneys, and nerves. The longer your blood pressure
stays high, the more damage it can do.
Problems can travel in the other direction, too: Damage to the kidneys can
lead to high blood pressure. The reason is that your kidneys play an important
role in regulating your blood pressure, and if they have been assaulted by
diabetes, they can lose some of their ability to do this.
In Chapter 12, we will look at how diet affects blood pressure. For now, here
are your targets.
Normal blood pressure is less than 120/80 millimeters of mercury (mmHg).
If you have high blood pressure, your caregiver will work with you to reduce it
to below 140/90, and to below 130/80 if you can get there without serious
medication side effects. If you are pregnant, the target will be 120–160/80–105,
aiming to protect both you and your baby.
5
It goes without saying that diet changes are key for controlling blood
pressure and can often make medications unnecessary. The same plant-based diet
that helps you lose weight and brings down your blood sugar will also help you
control your blood pressure.
Have your blood pressure checked regularly. If it is not where it should be,
take another look at your diet and speak with your doctor about what, if any,
additional treatments you may need. A healthful diet and the weight loss it brings
can also mean that your caregiver will cut back on blood pressure medicines you
may be on, or stop them altogether. But don’t stop your medicines on your own.
CHECKING YOUR KIDNEY HEALTH
Because your kidneys can easily be affected by diabetes, your doctor will check
your kidney health with a simple urine test at least once a year. The goal is to see
whether your kidneys are losing protein, specifically a protein molecule called
albumin. Albumin itself is not especially important. What is important is that if it
shows up in your urine, it is a sign that your kidneys have been affected by
diabetes and are not holding on to albumin as they should. Albumin losses of
greater than 30 milligrams over 24 hours are considered abnormal. Your doctor
will also check your blood for creatinine and estimate your glomerular filtration
rate and will interpret the results of these tests for you. For more on factors that
influence kidney health, see Chapter 13.
OTHER ROUTINE LABORATORY TESTS
Your doctor will run other tests to track your progress. The following are two
very common ones.
Complete blood count (CBC). This test shows the state of your blood cells.
Many people with diabetes develop anemia, meaning they have fewer red blood
cells than they should. A complete blood count lets your doctor easily check this
and many other measures. If your blood count is low, your doctor will
investigate the reasons for it, which could include kidney disease, iron
deficiency, use of certain medications, abnormal bleeding, or other factors.
Chemistry panel. A routine chemistry panel is also known by several other
names. It assesses your overall health, with a special focus on the status of your
kidneys and liver and lets doctors check for potential adverse effects from
medications.
There is no reason to despair if any of your laboratory values are not where
they should be, but it is definitely a reason to take action. You will want to
optimize your diet and work with your doctor to plot a course for tracking the
effectiveness of your overall health regimen.
TAKING STOCK OF YOUR DIET
I would like to shift gears now and look at your diet and overall health. First,
let’s take a minute to make sure that your diet is going according to plan.
Are your foods vegan? You know you are doing well if there are no foods of
animal origin on your plate, not even little bits of fish, fat-free milk, or egg
white—nothing. If you have done this right, there is no animal fat, no
cholesterol, and no animal protein in your diet. Your menu is built from plant
foods, and it is rich in fiber and all the healthy nutrients the plant kingdom
brings you. If you need a refresher on why you are doing this, please take
another look at Chapter 4.
Are your meals all low in fat? It is important to really keep fats and oils to an
absolute minimum. Be careful with nuts and nut products.
Are your foods low GI? The main problem foods are sugar, corn syrup (a
common sweetener in processed foods), white and whole wheat breads
(favor rye and pumpernickel), and baking potatoes (choose sweet potatoes
and yams).
QUICK FIBER CHECK
One way to help gauge how you are doing is with the Quick Fiber Check. It is a
handy little tool, and I suggest that you do one about once a week as you begin
this new approach to eating. Scoring is simple and takes only a minute or two to
learn. Soon, estimating the fiber content of virtually everything in the
supermarket will be a snap. You will also see if you are getting enough fiber in
your daily menu. It does not take long, and it will help you see if you are on
track.
First, take a minute to jot down everything you ate or drank for 1 full day on
a form similar to the example below. I will explain below how to fill in the fiber
column.
Then, next to each food, note its fiber score, using the following guide.
Beans: For each serving of beans or lentils (one serving = ½ cup) or any
food that includes about this amount of beans or lentils as an ingredient, give
yourself a 7. One cup of soy milk or ½ cup of tofu (both made from soybeans)
rates a 3.
Vegetables: For each serving of vegetables (one serving = 1 cup), give
yourself a 4. An exception is lettuce, for which 1 cup scores a 2. A potato with
skin scores a 4; without the skin, a 2.
Fruit: For each medium piece of fruit (e.g., an apple, orange, or banana; 1
cup applesauce; a banana smoothie), mark a 3. For 1 cup of juice, mark a 1.
Grains: For each piece of white bread, bagel, or equivalent, score a 1.
Whole grain breads score a 2, as does 1 cup of cooked pasta. One cup of rice
scores a 1 for white and a 3 for brown. One cup of cooked oatmeal scores a 4.
Score a 3 for typical ready-to-eat cereals, a 1 for highly processed and colored
cereals, and an 8 for bran.
Soda, water: Score a 0.
Interpreting Your Score
Total your fiber score and let’s see how you are doing.
Less than 20: You need more fiber in your diet. As it is, your appetite will
be hard to control, and you may have occasional constipation. Boosting fiber
will help tame your appetite and cut your risk of many health problems.
20–39: You are doing better than most people in Western countries, but as
you bring more fiber into your diet, you will find that it makes foods more
satisfying and cuts your calorie intake a bit.
40 or more: Congratulations! You have plenty of healthy fiber in your diet to
control your appetite and help keep you healthy. Fiber also reduces your risk of
developing cancer, heart disease, diabetes, and digestive problems.
CHECKING YOUR WEIGHT
Of all the things that predict success in dealing with diabetes, leaving behind
excess weight is among the most important. The strategy outlined in Chapter 6 is
a highly effective way to go about it.
Here are some tips for tracking your progress.
First, track your weight. Some people who have been overweight for a long
time have not gone near a scale in years. If that sounds like you, give it
another try. It is essential to know if you are losing. If you are not losing
weight, it is time to change course. Usually, that means tuning up your diet.
Weight loss is sometimes difficult, and genetic tendencies do play a role, but
your diet is one thing you really can control.
Use the same scale each time you weigh yourself. Different scales can give
dramatically different readings.
Check your weight at the same time of day each time. With food and water
intake, you can easily gain and lose a few pounds in the course of a day.
Usually, you will be heavier in the evening.
In gauging the success of your weight loss, about 1 pound per week is a
healthful goal. It is about what you can expect if you follow the diet
presented in this book without doing particularly vigorous exercise. Slower
weight loss is also fine as long as you are moving in the right direction.
Do not rely on exercise alone for weight loss. A healthful diet change can
easily trim 300 to 400 calories a day off your daily menu, but burning that
many calories through exercise means walking or running 3 or 4 miles a day.
Exercise is important, but it cannot begin to take the place of diet changes.
CHECKING YOUR EYES
At least once a year, you should have an eye examination by an ophthalmologist
to check for any sign of retinopathy. These changes cannot be detected by an
ordinary eye examination with a doctors ophthalmoscope or during an
optometric examination for eyeglasses. Also be sure to see an eye specialist if
you have had any changes in your vision.
If you smoke, tell your eye doctor. Yes, you will get a lecture, and it is time
to listen up if you are still smoking. See Chapter 13 for information on the
effects of nutrition on eye health.
CHECKING YOUR FEET
Foot problems are common in diabetes. If your blood glucose has been poorly
controlled, you are at risk of developing neuropathy—nerve damage—which
means you may not be aware of small injuries to your feet. Wound healing may
be slowed as well. Small injuries can gradually worsen and become infected.
For this reason, you not only want to get your diet into shape by following
the guidelines in this book, you also want to have your doctor check your feet at
least once a year. The examination will include a check for sensation using a thin
plastic thread, a check of your vibratory sense with a tuning fork, and a thorough
check for any signs of damage to your skin. Take the advice of Mary Ellen
Wolfe, RN, a nurse working with George Washington University, who
recommends that you take off your shoes and socks at every doctors visit to be
sure your doctor does not forget to examine your feet.
STAYING HEALTHY
No matter how healthy you get, you should still keep an eye on your glucose,
A1C, and cholesterol; blood pressure; weight; eyes; and feet. But I hope as you
tune up your diet and lifestyle, that it’s all you will be doing—just confirming
that all is just as it should be.
CHAPTER 8
A Perfect Diet in an Imperfect World
It is not always easy to follow a perfect diet in an imperfect world. There will be
times when those you depend on—restaurants, airlines, co-workers, and even
family members—have little understanding of or interest in healthy foods. This
chapter is dedicated to these situations. I will cover dining out, travel, social
situations, working with your doctor, and dealing with family members. When
life throws you a curve-ball, I will show you how to step up to the plate and stay
in the game.
DINING OUT
Dining out is part of life, and you ought to be able to enjoy a night on the town
with friends or loved ones without missing a beat on your new healthy diet.
Luckily, many restaurant menus offer plenty of healthy selections. Unfortunately,
others are limited. Often the key to success lies in where you go and what you
order when you get there. Here are a few tips.
First, think international. In Mediterranean countries, Asia, Africa, and
Latin America, the traditional dietary staples are grains, vegetables, legumes,
and fruits. Not surprisingly, all of these regions have historically had much lower
rates of diabetes than North America and Western Europe. When you choose
from the best of what these cuisines have to offer, dinner out can be both healthy
and delicious.
Italian restaurants are everywhere, and they would love to serve you
spaghetti with a marinara or arrabbiata sauce, minestrone, pasta e fagiole (a
traditional soup made with pasta and beans), healthy salads, chunky vegetable-
and-tomato pizza, grilled asparagus, and steamed spinach. Because their foods
are usually made to order, it is a snap for chefs to minimize oil, leave off cheese,
serve sauces on the side, and so on.
Mexican restaurants are ubiquitous in North America and serve bean or
vegetable burritos, veggie fajitas, rice, and salads. Most have stopped using lard
to make their beans, and all are happy to skip the cheese. Top foods with salsa if
you like.
Latin American cuisine comes in other wonderful varieties, too. Cuban and
Brazilian restaurants offer black bean dishes, rice, plantains, salads, salsa, and
other healthful fare.
Chinese restaurants will get you started with vegetable spring rolls or
vegetable pot stickers and various healthy soups. Favor the steamed, not fried,
items. Skip the meat dishes and get right to the long list of savory vegetable
main dishes made with tofu (also known as bean curd), green beans, broccoli,
spinach, and other healthful ingredients. The danger in Chinese restaurants, as in
most eating establishments, is overexuberance with the use of oil. Ask that your
food be prepared with as little oil as possible and have your main dish along with
plenty of rice, preferably brown rice.
Japanese restaurants are among the very best choices when it comes to
healthful dining. Sushi chefs are delighted to transform carrots, cucumbers,
radishes, sweet potatoes, and other simple ingredients into edible delights. Have
them along with miso soup, salads, seaweed, and various appetizers.
Thai and Vietnamese restaurants serve many meatless dishes that include
rice, soft noodles, vegetables, and tofu along with wonderful sauces.
Indian restaurants are mixed. While vegetarian diets are traditional and
highly respected among many Indians, the use of oil and dairy products often
puts them in the no-go zone. Your best choices are soups, rice dishes, and
vegetable curries prepared with minimal oil.
Ethiopian restaurants are common in major cities. Because some religious
groups in Ethiopia follow vegan diets during certain days of the week and
certain times of the year, the restaurants serve many dishes made with chickpeas,
split peas, lentils, green beans, peppers, and delightful spices. They will be
happy to serve you all their vegan items on a large platter for a wonderful dinner.
American restaurants, family restaurants, and even steakhouses have salad
bars and offer vegetable plates. Many serve pasta dishes even when they are not
on the menu.
Second, ask for what you want. If what you are looking for is not on the
menu, do not be afraid to ask. Most restaurateurs will gladly alter their main
offerings to accommodate a special request. If you would like cheese and bacon
bits left off your salad, if you would like a vegetable plate, or if you would like
your pasta topped with tomato sauce instead of meat sauce, by all means, ask.
You will not only get a better meal, you will also help the restaurant
management understand how to better serve patrons like you.
As I noted above, restaurant kitchens often overdo it with oils, so ask your
server how foods are prepared and request that your meal be made with as little
oil as possible. In Italian restaurants, spinach and broccoli are often sautéed, but
they can also be steamed. The same goes for most Asian vegetable dishes.
Sauces and condiments can always be served on the side. This goes for pasta
sauces, salad dressings, brown sauces used in Asian cuisine, spreads used on
sandwiches, and similar items.
Ask for what you want. You will be glad you did.
A Breakfast Trick
most restaurants will gladly serve a healthful bowl of oatmeal for breakfast and
will top it with strawberries, blueberries, or cinnamon. But once in a while,
you’ll find precious little at eateries that are busy serving bacon and eggs. Here’s
a trick:
Ask the server to have the cook throw some tomatoes, spinach, and
mushrooms on the grill. Maybe some asparagus, too. Chefs are accustomed to
stuffing them into omelets; now, you’re just having them without the eggs! With
a side of rye toast (no butter, of course), you’re set.
Fast Food
Fast food is rarely a top choice when the priority is healthy eating. On the other
hand, these chains are big businesses that understand the growing demand for
healthy food choices. More and more often, you find offerings on their menus
that fit into a healthy diet.
Taco Bell’s bean burrito—if you hold the cheese—is entirely vegan. If you
like, add tomatoes, lettuce, or jalapeño chile peppers.
Burger King offers a veggie burger that is much lower in fat than its other
sandwiches and will also gladly sell you a Veggie Whopper with all the toppings
but without the burger. Submarine sandwich shops will gladly leave off the meat
and cheese and pile on the lettuce, tomato, cucumbers, spinach, and peppers,
plus a dash of red wine vinegar. And they will even toast it for you. Denny’s
offers a veggie burger, and most family restaurants serve plenty of side
vegetables that together make a good vegetable plate.
Some fast-food restaurants offer salad bars. With chickpeas, three-bean
salad, cherry tomatoes, and chopped vegetables, a salad becomes a hearty meal.
In that vein, one of the best ways to get healthy food fast is to stop at any
large supermarket and patronize its salad bar. A wealth of great choices is right at
your fingertips.
NANCY’S AND VANCE’S EXPERIENCES
Nancy often dined with friends who liked good food and good restaurants. I
encouraged her to choose ethnic cuisine—Chinese, Japanese, Italian, or Thai, for
example. Unfortunately, that was not what most of her friends had in mind, and
they felt uncomfortable knowing she would not eat unhealthy things.
When she headed out to join friends at a restaurant that might not be very
accommodating, she often had a snack in advance so she would not be starving
when she got there. When she went to open houses during the winter holidays,
she often volunteered to bring a fruit and vegetable tray.
On a vacation to Iceland, she packed granola bars and individual soy milk
packages in her luggage, to supplement the local food, and got by just fine.
“I am tempted sometimes, especially when I am stressed or overtired. I talk
myself out of it,” she said.
She found it helpful to keep things in perspective. “You have to decide what
your priorities are,” she explained. “I didn’t want to suffer from the effects of the
disease. I wanted to stop the progression. I didn’t even think about reversing it.
And now I’m a walking advertisement for the program. People keep asking me
how I’ve done it. I’ve described it in detail to probably 40 people.”
When Vance dined out, he looked for veggie burgers, fresh steamed
vegetables, and pasta without cheese and oils. His challenge was sports
stadiums. “I love going to baseball and football games, where french fries, hot
dogs, and soft drinks are about all that’s offered. It would be great to be able to
bring in healthy food or even just some carrot sticks and a bottle of water, but
usually they don’t allow any food to be brought in. So at first I stuck to pretzels,
popcorn, and Crystal Light. At a game in Seattle, I smelled the fish and fries, and
it was hard to resist,” he said.
Veggie hot dogs and burgers came to Vance’s rescue. Although they are not
necessarily the ultimate dining experience, they are a major improvement on the
foods they replace, and more and more stadiums, movie theaters, and other
venues are starting to sell them.
TRAVEL
Travel presents challenges no matter what kind of diet you follow. Here are a
few ways to help keep your new eating plan on track.
Choose restaurants wisely. As you have seen, there are usually plenty of
vegan choices at nonvegan restaurants, particularly those that feature
international cuisine. Even some fast-food places can rise to the occasion.
You might go online to check out vegan and vegetarian restaurants in cities
you are planning to visit. A Web site called Happy Cow’s Vegetarian guide
(happycow.net) lists them by location, but call before you go; restaurants are
forever starting up and shutting down. There’s no reason to limit yourself to
these restaurants, though; almost any eating establishment should be able to
accommodate you.
Plan before you fly. When you are booking an international flight (or
generally up to 48 hours before your flight), request a vegan meal. You will get a
healthy meal and will often be served first.
On domestic flights, most meal service has gone by the wayside, so you
might pick up some easy-to-pack snacks at a health food store or supermarket.
Vegan deli slices are great sandwich fillers and resist spoiling. A pack of
hummus with pita bread, a few pieces of fresh fruit, some baby carrots, instant
soup cups (flight attendants will gladly provide hot water), or a small pop-top
can of chickpeas can be lifesavers.
SOCIAL EVENTS
It can be tough to stick to the plan at parties, even when you know you will
regret a slip in the morning. If you arrive at a party unprepared, there may well
be nothing available that you can eat. With a bit of planning, though, you can
celebrate without leaving the healthy path you are on. Here are some ideas.
Offer to bring a healthy dish. Let’s say you have been asked to the home of
some friends for dinner, and you have no idea what they will serve. Here is what
I suggest: When you get the invitation or as soon thereafter as possible, call your
hosts to let them know that you have changed your diet and that you do not want
to put them to any trouble. Say that you would like to bring something, such as a
low-fat hummus dip or an exotic fruit salad. I can almost guarantee that your
hosts will say there is no need to worry and you need not bring anything because
there will be plenty to eat. Now, regardless of what they were really thinking,
you have alerted them to your needs without imposing in the slightest.
If you are reluctant to let your hosts know, do not be. They will be much
more embarrassed if they find out after the fact that they served a dinner with
nothing you wanted to eat. Besides, you are very likely to find that other guests
—and even your hosts—are making similar diet changes.
Bring a healthy gift. Instead of the usual bottle of wine, why not arrive with
a healthful food gift? A fruit basket, a loaf of artisan pumpernickel bread, or a
healthy party dip (you can find all of these at health food stores) will delight
your hosts and ensure that you have something to eat.
Avoid arriving hungry. If you arrive ravenous, you will be drawn to the
platters of unhealthful foods. If you eat something before you arrive, you will be
fine.
Carry a plate. Party guests with nothing in their hands are inviting others to
offer them something. Make yourself a plate with a few crudités or a bit of
bread, and no one will be inclined to offer you foods you do not want to eat.
AT THE DOCTOR’S OFFICE
Medical care is a partnership; you and your doctor need to work together to best
meet your needs. This is true at any time, but especially when you are in the
process of changing your diet. The fact is, your diabetes will probably be
improving, and you will need to ratchet down your medications.
Some doctors are not easy to reach, and even if you have your doctors
attention, that does not mean he or she wants to engage in a conversation about
nutrition. Some physicians show little interest in the topic, while others have
frankly outdated or untested ideas about it.
I suggest you lend a copy of this book to your physician with a sticky note
flagging Chapter 14. It was written for doctors and shows them how they can
best help you.
You can help by holding up your end of the partnership. That means
following your doctors advice (provided it is sound and you agree with it),
letting him or her know how you are doing, calling promptly if your blood
glucose drops below 70 mg/dl (3.9 mmol/l) or whatever other criterion is set,
and taking a vitamin B
12
supplement so he or she will not worry about your
developing any sort of deficiency. The truth is, your nutrition is much better on a
vegan diet than on an omnivorous diet, but a knowledgeable doctor will want to
be sure you are getting your B
12
. A supplement will easily take care of that.
In the vast majority of cases, doctors are delighted when their patients
improve their diets. They are all the more delighted when they see the
improvements on the scale and in laboratory results.
One of our research volunteers thought his doctor would be skeptical about
his plans. They talked about little aside from blood tests and prescriptions during
his appointments. To his surprise, however, when the doctor found out he was
starting a vegan diet, she was delighted. “That will probably help you a great
deal,” she said. And indeed, it did. Within 6 months, he lost 30 pounds, was able
to stop one of his two diabetes medications, and was continuing to improve week
by week. His doctor had no formal education in nutrition, but she knew success
when she saw it. She now recommends the same diet to other diabetes patients.
LOVED ONES WHO HELP AND HURT
Sometimes our friends and family members help us stay on a healthy path. When
we are not enthusiastic about exercising, they encourage us by going with us.
When we are tempted by some less-than-healthful food, they shore up our
resolve.
Improving our diets is like quitting smoking or breaking any other habit: We
need our family’s support. But sometimes, intentionally or unintentionally, our
loved ones are not so helpful. They may not be aware of the risks of a bad diet,
or perhaps they are all too aware and are struggling with unhealthful habits of
their own. They may even try to sabotage your efforts to break bad habits.
If the problem is that your loved ones simply do not have much information
about healthful diets, lend them this book. If they are not eager readers, try this
little trick: Put a sticky note or bookmark at any page you think they would find
of special interest. They will be drawn to that section, and once they start
reading, they will probably continue.
If family members tease you about your eating habits, remind them how
important your health is to you. Explain that it is tough for you to have
unhealthful foods around and that you really need their help. Ideally, they will
join you in your new, healthy way of eating. If they just will not change, then at
a minimum, they must keep their food separate and not tease or tempt you with
unhealthy items.
GOOD FOOD FOR THE WHOLE FAMILY
If you are preparing meals for your family and they are balking at new foods, do
not despair. It is natural to be cautious about anything new. Present healthful
foods without pushing them and recognize that it often takes a couple of tries
before a new item really catches on.
I suggest that you not fix healthy meals for yourself and less-than-healthy
meals for your spouse or children. Some people do this, figuring they cannot
change others’ bad habits. But remember this: Not only will introducing
healthful foods to your family bring you some very important allies, it will
benefit your loved ones as well as you.
The very best situation is when the whole family decides to change together.
There is no health reason for anyone to eat animal-derived foods, fatty foods, or
sugary foods. Yes, these foods are everywhere in modern societies, but they are
the principal reason for the epidemics of overweight, heart disease, cancer, and
other health problems in North America and much of the rest of the world. When
the whole family makes the same diet change, they all get the same advantage.
One good way to break through resistance is to ask your family members to
try a short-term diet change with you as an experiment. Say that you’d like to try
new and healthy ways of eating for just 3 weeks, and you would like them to
join you. Most people will try anything for a short period. By the time 3 weeks
have passed, they will have sorted out the new foods they like and will be ready
for more.
When introducing healthful foods to children, it is generally best to stick to
simple, familiar items. Some children may not yet care for exotic vegetables, but
they will easily gravitate to fruit of all kinds, as well as corn, green beans,
carrots, peas, and other simple foods. Avoid wrangling with a child who is
reluctant to try a new food. Sometimes altering the form of the food makes a
huge difference. A child who does not care for the texture of cooked spinach
may like fresh spinach as part of a salad. Steamed broccoli and cauliflower may
be intimidating, but they may be perfectly acceptable when chopped and added
to a soup or stew. Kids may not go for lentil loaf, but they love veggie burgers
and hot dogs and sandwiches made with vegetarian deli slices.
It always helps to present choices. Would your children prefer baked beans
or lentil soup? Would they prefer their veggie burgers cut into halves or
quarters? The idea is to give kids a sense of control while all the possibilities are
good ones.
In some families, food is a symbol of affection. Parents stuff their children
with cookies and gooey desserts, as if love could be measured in calories.
Whatever the motivation, none of this does you one bit of good. Find other ways
to express affection. A book, a walk, a trip to the movies—there is no shortage of
meaningful gifts.
HEALTHFUL FOODS IN AN UNHEALTHY WORLD
A visitor from another planet might well conclude that modern civilization has
no perceptible interest in healthful diets. Fast-food restaurants—and regular
restaurants—carry lots of fatty, cholesterol-laden meals and far fewer healthful
choices. Television commercials push endless less-than-healthful snacks.
Convenience stores and snack machines offer lots of what you do not want and
precious little of what you do want. Sometimes, you may feel like a person who
is trying to quit smoking but is trapped in a bar where cigarettes are free.
In large part, you would be right, but truly, there are also plenty of healthful
options. For every convenience store selling unhealthy food, there is a
supermarket with an ever-expanding range of great food products. For every
restaurant that refuses to serve anything health-conscious eaters would look for,
there are a dozen that offer good choices. The range of health-oriented
cookbooks is truly enormous, and it is now easier than ever to follow a healthful
diet. Friends and family members—even those who do not follow healthy diets
themselves—all know that what you are doing is worth supporting.
CHAPTER 9
Troubleshooting
How are you doing with your new way of eating? Are you reaching your weight-
loss goals? Are your glucose and A1C coming down? Is your cholesterol
improving?
If you are having any sort of trouble, this chapter will guide you through the
most common problem spots.
NOT LOSING WEIGHT
People who begin low-fat, vegan diets typically lose weight easily. In our
research studies, the average rate is about 1 pound per week. Some people lose
more quickly, others a bit more slowly, but a pound a week is a good pace. If you
think about what this means over a years time, the result is impressive,
particularly since you are free of the yo-yo syndrome that comes with diets
based on calorie restrictions. Because this is not a short-term, starve-yourself-
thin diet, it does not cause hunger, so there is no rebound bingeing. Gradual,
healthy weight loss is what you can expect. Sometimes losing weight can be a
bit like following the stock market. There are fluctuations up and down, but the
trend should be clear. If you are not losing weight, it is time to take action. Here
are the steps to take.
Get back to the basics. Be sure you are following the guidelines in Chapter
4 and giving it 100 percent. That means no animal products in your diet at all. If
your diet includes fish or cheese, for example, your weight-loss efforts will be
hampered.
Check for hidden oils. Packaged foods should include no more than 3 grams
of fat per serving. If you frequently eat at restaurants, try to assess to what extent
they are packing oils into their meals. If you are unsure (or your server is
unsure), ask for foods to be steamed rather than fried or sautéed and that any
sauces or dressings be served on the side. See Chapter 8.
Do a Quick Fiber Check. If you check your fiber intake and find that you
are eating less than 40 grams of fiber per day, you’ll want to bring in more
beans, vegetables, and fruits.
If your diet is vegan, low in fat, and high in fiber, it is very hard not to lose
weight. Even so, here are a few things to consider.
Simplify. It pays to choose simple foods rather than processed food products.
The fewer ingredients, the better—one is ideal. Beans, broccoli, carrots, or
brown rice, for example, do not need an ingredients list, because what you see is
exactly what you get. You know that no one has added any oil or processed away
any fiber.
Add more raw foods. Some people have had remarkable weight loss as a
result of increasing their intake of raw foods. Chopped vegetables, salads, fresh
fruit—these are all rich in fiber, with no added fat and low GIs.
Don’t Get Sidetracked by Rationalizations
Sometimes people who are not losing weight blame genetics, lack of exercise, or something
else for their problem. Genetics and exercise do play roles, of course. But if you are not losing
weight, the problem is nearly always dietary.
Once, en route from Washington to London, I was busily typing away on my laptop, writing
an article about diet changes for weight loss. The passenger next to me happened to see what
I was typing and took an interest in the topic. He had been overweight for several years and
wanted to see what I might suggest. I explained our research findings about how diet changes
could cause lasting weight loss. I pointed out that the key seemed to be changing the types of
foods we eat. I launched into a discussion of the benefits of vegetables, fruits, beans, and
whole grains and the wonderful meals they can become.
“That’s interesting,” he said, “but I think I just need to exercise more. That’s my real
problem. I used to exercise a lot, but lately, I’ve been so busy.” He brushed aside the whole
topic of food.
A few minutes later, the flight attendant came by with the meal service. She served him a
ham-and-cheese sandwich, a bag of chips, and a soft drink, which he shoveled into his mouth
without a word. I suspect he did not realize that it would take a very long session at the gym to
burn away those unnecessary calories. The airline also served vegetarian meals, which would
have been a much better choice.
Shortly thereafter, I was talking to a patient with Stanley Talpers, MD, an internist on the
faculty of the George Washington University School of Medicine in Washington, D.C. The
patient said he hadn’t been losing weight, and he figured that he just needed to walk more. Dr.
Talpers encouraged him to get his diet in order first because, he said, “to lose a pound by
walking, you’d have to walk to Baltimore.” It is true. Exercise is beneficial, and I strongly
recommend it. But a lack of exercise is not the primary reason for weight problems, and
exercise can never take the place of a healthful diet.
BLOOD GLUCOSE NOT COMING UNDER CONTROL QUICKLY
ENOUGH
The primary way of tracking your glucose control is with hemoglobin A1C. As
you know, the American Diabetes Association’s goal is to have your A1C under
7.0 percent. If you are not making good progress toward your goal, here are
some points to consider.
Get back to the basics (again). If you are overweight, weight loss is the
strongest predictor of a healthy drop in A1C. To jump-start weight loss, take a
look at the tips above and in Chapter 6. Whether you are overweight or not,
those same points are also the keys to bringing your glucose under control.
If your diet is vegan, it has no animal fat in it, of course. And if you are
setting aside vegetable oils, it has very little of any kind of fat. With these
healthy changes, you can just imagine those little bits of fat inside your muscle
cells starting to shrivel up. As you saw in Chapter 2, these are the bits of fat that
appear to be the cause of insulin resistance.
Embrace healthy carbohydrates. Many people tie one arm behind their
backs by avoiding starchy foods. They imagine that beans, lentils, pasta, sweet
potatoes, or yams will push their blood glucose upward. And, of course, if you
check your blood glucose after just about any meal, it will be higher than it was
before. However, don’t let this turn you against starchy foods and back toward
fatty or high-protein foods. Here is why.
The fat in fish and chicken will tend to arrest your weight loss. It will also
tend to aggravate your insulin resistance. Here is what happens in a typical case.
A man has heard that “carbs are bad” or perhaps notices that his blood
glucose has gone up briefly after a meal of rice or starchy vegetables. He decides
to avoid carbohydrates and adds fish and chicken back into his diet. At first, it
seems like a good change. His blood glucose does not spike strongly after meals
because there is very little starch in his meals to provide glucose. “Aha!” he
says. “I’ve found the diet to keep my blood sugar down!” over the next several
days, however, he notices that his fasting blood glucose values are heading in the
wrong direction. They go up bit by bit, and after a week or two, the rise is
significant. “Now what?” he thinks. This is what is going on:
There are only three sources of calories: carbohydrate, fat, and protein. In
avoiding carbohydrate, he was left with fat—which tends to increase insulin
resistance—and protein, which has problems of its own. The increased fat intake
did not increase his blood glucose immediately, but fatty diets tend to increase
the amount of fat inside the cells. The result is that insulin resistance gradually
worsens. This means that any carbohydrate he ate later would cause a bigger
blood sugar spike than it otherwise would have. As the days went by, his blood
sugar gradually increased.
The answer to this is to avoid fatty foods and choose healthy, carbohydrate-
rich foods, letting the glycemic index help you choose the best of them (see
Chapter 4). This means legumes (beans, peas, and lentils), vegetables, fruits, and
whole grains.
Meals will always cause a temporary rise in blood glucose; what you are
looking for is an overall trend downward as your insulin sensitivity gradually
improves.
See your doctor. One common reason for rising blood glucose levels is
infection. A cold, a urinary tract infection, a foot sore, an ear infection—you
name it. They all tend to raise your blood glucose. Sometimes a surprisingly
small cut or a cough you’re hardly aware of boosts your fasting blood sugar
values. As the infection heals (with medical treatment as needed), your blood
glucose will recover. Your doctor may decide to adjust your diabetes medications
in the interim.
Check your stress level. Stress raises blood sugar. The fight-or-flight
response—the physical reaction that gets you ready to fight or run away from
danger—can kick in with any sort of threat, real or imagined. A rise in blood
sugar was much more useful when the threats we encountered were predators
and warring tribes. That extra blood sugar fueled the muscles needed to run or
fight. Today, we are more likely to be threatened by job worries, financial
difficulties, or relationship problems, and rising blood sugar doesn’t help during
those times. But stress still evokes the response, and it still causes a blood sugar
spike.
If stress is temporary, you will see your glucose spike resolve quickly. If
stress is ongoing, get help. Meditation, yoga, and other techniques can help you
deal with stress. If the problem is deeper—if you are headed into depression or
chronic anxiety—do not try to be a hero. See a qualified mental health
professional and get started with a treatment that works for you.
Exercise. If you are sedentary, now is the time to bring physical activity into
your life. Vigorous exercise helps reduce blood glucose levels. See Chapter 11.
In most cases, these steps will help bring your blood sugar down. If it
remains high despite your best efforts, your doctor will want to adjust your
medications.
PERSISTENT HUNGER
If you are cutting back on calories in an effort to lose weight, you may be left
feeling hungry. One of the reasons I recommend a low-fat, vegan diet is that it is
so substantial—it provides plenty of fiber to fill you up and has no limits on
portion sizes or calories. The result is weight loss without hunger. In our
research studies, we use a questionnaire to measure hunger along the way, and
we consistently find that this way of eating leaves people feeling satisfied.
What if your meals don’t quite hold you, though? Here are some suggestions,
starting with the obvious one.
Eat more. Maybe that little bowl of oatmeal is just not enough. When you
are just getting to know new foods, it takes a little time to figure out the right
serving sizes. You will soon sort this out.
Go low GI and high fiber. If you have instant oatmeal for breakfast, you
will get hungry sooner than if you have the old-fashioned variety. The difference
is simply that instant oats have had their fiber sliced up. Instead of flat rolled
oats, you have a box full of oat powder. That means that they cook quicker but
also that they digest quicker, spike your blood sugar quicker (that is, they have a
higher GI), and leave you hungry quicker. Eating foods that are in as natural a
state as possible prevents that overly rapid digestion and helps keep hunger at
bay.
You want foods that have both a low GI and high fiber content. A food that
offers one doesn’t necessarily have the other. For example, whole wheat bread
has lots of fiber, but something about the wheat grain causes it to release its
natural sugars into the bloodstream rather quickly (i.e., it has a high GI). In fact,
white bread (which has had its fiber removed) has virtually the same GI as whole
wheat. In contrast, rye bread digests more slowly, releasing its natural sugars into
the bloodstream more gradually, which means it has a low GI. To check your
fiber intake, do a Quick Fiber Check.
Have healthy snacks. There will be many times when you will want to have
a bite to eat between meals, and you should! See Chapter 5 for a discussion of
the best choices.
QUIETING CRAVINGS
If you have had diabetes for any length of time, you have already been coping
with the ubiquitous nature of junk food. Unhealthy snacks are everywhere. But
why do they call to us as they do? Why is sugar or chocolate sometimes so
attractive? Why is cheese or meat sometimes hard to resist? Where do cravings
come from?
One of our research participants once asked me what was wrong with her.
She had had diabetes for 12 years, and even though she knew that she should
stay away from sugary foods, she craved them. Especially when she was stressed
or tired, cookies, chocolate, and pastries seemed to call her name. She had the
cravings nearly every day. “I think I’m just a weak-willed person,” she said. She
was embarrassed about her cravings and found herself avoiding the subject when
she spoke to her dietitian.
Here is the most important thing to understand about cravings: They are not
caused by weak will or gluttony. Cravings are triggered by biological properties
of the foods themselves. That is, certain foods have chemical makeups that cause
us to crave them in very much the same way that drugs, alcohol, and tobacco
have addictive components.
Let me be clear: Only certain foods lend themselves to cravings. The same
foods are alluring to almost everyone.
Four types of foods trigger biochemical effects not unlike those of addictive
drugs. They are not as strong or as dangerous as drugs, but the chemistry of
addiction does seem to be at work with these foods. I have described these
effects in detail in a book called Breaking the Food Seduction. Here, I will
summarize the main points you need to know. The four categories of addictive
food are sugar, chocolate, cheese, and meat.
Sugar. Sugar is not simply sweet. In addition to its taste, it also has a mild
druglike effect. That is, it affects the brain in essentially the same way as opiate
drugs—morphine and heroin, for example—albeit not as strongly. This effect
helps explain why people crave sugar, especially during times of stress.
How do we know that sugar has this effect? In controlled studies, researchers
use a medication called naloxone as a research tool. Nalox-one is normally used
in emergency rooms to block the effects of heroin or other opiates. If a person
has overdosed on heroin, doctors inject naloxone, which blocks the heroin (and
any other narcotic) from attaching to receptors in the brain. A comatose drug
addict, previously on the verge of death, rapidly awakens with a dose of
naloxone.
Researchers have given naloxone to volunteers and offered them various
sugary foods. They then measured how much the volunteers ate and compared
the results to those of the same test done without naloxone.
It turns out that naloxone causes a noticeable drop in sugar cravings.
Normally, you might long for a glazed doughnut or piece of pie, but with a dose
of naloxone, much of the attraction is gone. The effect is particularly clear for
foods that contain both sugar and fat: cookies, cakes, and ice cream.
Naloxone is given intravenously and is not a treatment for food addiction; it
is a research tool. These experiments show that sugar does not simply delight the
taste buds; it also stimulates the release of opiate chemicals in the brain. Just as
intense exercise causes the release of endorphins—natural feel-good chemicals
within the brain—sugar seems to do something very similar.
Let me be clear about this: Sugar does not contain opiates. Rather, the taste
of sugar on the tongue is what apparently triggers the release of opiates within
the brain. In turn, these opiates trigger the release of another natural chemical,
called dopamine, which is the key to the brain’s pleasure centers. Drugs of abuse
—heroin, cocaine, marijuana, tobacco, alcohol, and all others—increase
dopamine activity in the brain. Sugar appears to do the same. Evidence suggests
that the effects of sugar on the brain ease pain and discomfort and give us a little
boost. No wonder we turn to sugary foods, especially when we’re stressed.
Sugar has the same effects on infants just a few hours old. When babies have
a heel-stick to draw a blood sample, they cry noticeably less if a bit of sugar
water is dribbled into their mouth first.
Sugar cravings go beyond plain sugar itself. Some people also crave foods
such as white bread or bagels, which turn to sugar rapidly and release sugar into
the bloodstream. In essence, they crave high-GI foods—sugar, cookies, crackers,
white bread, potatoes, or cold cereals. While we also enjoy low-GI foods, we
tend not to crave them.
Chocolate. Chocolate’s addictive qualities have long been recognized in
psychiatric journals. And in scientific studies, the most ardent chocoholics’
desire falls away when they are treated with opiate-blocking drugs. These
experiments show that it is not simply taste or mouthfeel that keeps us hooked.
Chocolate also appears to have mild effects on our brains.
Chocolate’s attraction is not due simply to its sweetness. After all, no true
chocolate lover would be satisfied with sugar alone. Chocolate also contains
caffeine, theobromine, and phenylethylamine. These are all stimulants, and they
may play a role in chocolate’s seduction, aside from its opiate effects.
If you are a chocolate lover, you probably already know that chocolate is
more than a food: You don’t just feel you want it, you feel you need it.
Regrettably, chocolate carries not only a load of sugar but also a considerable
load of fat.
Cheese. Yes, it may smell a bit like old socks, but cheese is one of the foods
that people who are trying to improve their diets have the most trouble leaving
behind. There is obviously something besides fat and cholesterol in cheese that
accounts for its popularity.
That “something” may be the dairy protein, or casein. Like all proteins,
casein’s molecular structure is like a long string of beads, with each bead being
an amino acid. Normally, when proteins are digested, these amino acids come
apart one by one and are absorbed into the bloodstream to be used to build body
tissues and repair any damage to your body.
Casein behaves differently. As it breaks apart, it does not simply release
individual amino acids. It breaks into short strings of amino acids—strings of
perhaps four, five, or seven “beads.” They are not just the amino acid building
blocks for protein; they are also biologically active compounds with a mild
narcotic action. Scientists call them casomorphins—casein-derived morphinelike
compounds. If scientists were to feed you cheese and then take a sample of your
digestive tract contents, they would find an array of casomorphins with mild
narcotic actions. Some have speculated that the narcotic effects of casomorphins
are responsible for cheese’s attraction. These effects may also explain why
cheese can be constipating, since narcotic compounds slow digestion.
By now you know if cheese is your thing. If so, its fat and cholesterol
contents are conspiring against you. Shortly, we will look at how to kick this and
other food addictions.
Meat. Men, in particular, often describe meat as the very last food they
would ever want to give up. No matter how often they are reminded of what it is
doing to their waistline or cholesterol test results, many have trouble breaking
their emotional attachment to roast beef, steak, or chicken wings.
Once again, experiments with opiate-blocking drugs suggest that part of the
desire for meat may have its basis in opiate effects within the brain. Researchers
in England gave opiate-blocking drugs to volunteers and tested their desire for
ham, salami, and tuna. The results showed that when the opiate effects were
blocked, volunteers lost much of their interest in meat.
1
RESETTING YOUR PRIORITIES
If cravings are sabotaging your new food program, take heart. You are not the
victim of a bad upbringing or a gluttonous personality. The fact is, you are not
attracted to just any food, or even to most foods. You may like apples, oranges,
bananas, or asparagus, but you have never once turned to them for solace during
moments of stress. You have never raced off to a convenience store because you
just had to have cauliflower. You have turned to sugar, chocolate, cheese, or
meat because they have chemical effects on the brain. Some beverages, such as
wine or coffee, also have druglike effects and can be addictive. But as far as
foods go, those four are the ones that work their unfortunate magic on just about
everyone.
Before we see what you might eat instead of that sugary doughnut, candy
bar, or cheeseburger, let’s take a closer look at what happens inside your brain
when you eat these foods.
A network of cells deep inside the brain makes up what is sometimes called
your reward center. Indeed, it is responsible for feelings of pleasure. Without it,
life would be one big gray day.
The reward center is not there just for fun, however. It is there to keep you
alive and to maintain the species. Here is why: If you got absolutely no pleasure
from eating, you might forget about foods entirely! Likewise, if sex were a total
bore, the species would soon die out. Thus, when you eat or have sex, your
reward center gives you a little bit of dopamine as a kind of reward.
In the process, that dopamine release causes slight neurological changes,
changes that put high-priority status on repeating whatever you have just done.
“That was fun,” your reward center seems to say. “Let’s be sure to do that
again.”
In nature, this would mean getting a reward for finding a new food source or
a receptive mate, with the result that you would take advantage of your find
again and again. The problem is that this system is easily hijacked. Alcohol,
recreational drugs, tobacco—and yes, unhealthy foods—cause significant
dopamine release, so not only do you like them, you also want to have them
again and again. Your pleasure center rearranges your priorities to favor
whatever stimulated it most recently. You find yourself planning your day
around sugar or chocolate, just as an alcoholic might regularly think about where
the next drink is coming from. If you have ever wondered why these otherwise
banal foods have such sway, it is because they hijack your brain’s pleasure
circuitry and your internal priority-setting system.
Breaking Free
If the occasional taste of sugar or chocolate is really not a big part of your life,
there is no need to worry about it. But if your waistline is expanding before your
very eyes, or your health is suffering from your food habits, it is time to wake up
and smell the addiction. What do you do if you’re hooked?
The best way to deal with unhealthy foods is to avoid teasing yourself. Set
them aside completely, at least for now. Do not keep them in the house, and do
not buy them. There is no need to worry about whether you will return to them
in the future. For now, just leave them alone.
In the process, your brain’s priorities can return to what really is good for
you. You are likely to find that your desire for unhealthy foods fades the longer
you are away from them. The following steps will also help.
Eat a healthy breakfast, and don’t skip meals. Cravings kick in when you are
hungry.
Get regular exercise so you’re tired enough to sleep soundly, and be sure to
get plenty of rest. Cravings are stronger when you are not sleeping well.
Avoid situations that trigger cravings. Some people find that their cravings
are triggered by being alone, by television cooking shows, by concession
stands at movie theaters, or by certain friends who are preoccupied with food
problems of their own. Try to identify your triggers and eliminate them as
much as possible.
Getting the Taste without the Regrets
Sometimes a simple substitution can help you steer away from an unhealthful
food. Here are a few.
If you crave sugar: In recipes, maple syrup, molasses, sorghum syrup, and
granulated sugarcane juice (Sucanat) can sometimes substitute for table sugar.
These are hardly health foods! But the idea is to replace refined white sugar with
a smaller amount of syrup or juice. They’re so flavorful you won’t notice you’re
using less.
Stevia is an intensely sweet derivative of an herb from Paraguay. It is sold as
a dietary supplement (its use as a commercial food additive has not yet been
approved).
Sucralose (Splenda) is a calorie-free sweetener made from cane sugar to
which chlorine has been chemically added, greatly increasing the sweetness of
the final product. Sugar alcohols, such as mannitol, sorbitol, and xylitol, are low-
calorie sweeteners sometimes used in candies, chewing gum, and desserts. They
have about half the calories of table sugar. There are, of course, other artificial
sweeteners. The disadvantage of the lot of them is that they do not help you
break your love affair with sweets, so when artificial sweeteners are not
available, you will find yourself returning to sugar.
My friend and colleague Hans Diehl, DrHSc, founder of the Coronary Health
Improvement project, says the best thing to do for a sweet tooth is to “have it
pulled!” The idea is that if you set sweets aside, you will eventually just forget
about them.
Of course, the best choices are fresh fruits—nature’s sweet foods. It also
helps to make sure your diet has adequate complex carbohydrate—grains, sweet
potatoes, and beans, for example. These foods provide the energy you need in a
form that is much more healthful than sugar.
If you crave chocolate: Cocoa powder is essentially defatted chocolate. It
can be used in beverages and baking or turned into a dip for strawberries or other
fresh fruit. You can also find low-fat frozen ice cream substitutes made from soy,
as well as sorbets.
If you crave cheese: get to know nutritional yeast. Sold in the supplement
aisle of health food stores, nutritional yeast flakes (not brewers or bakers yeast)
add a cheeselike flavor to sauces and casseroles.
In recipes, you can replace ricotta or cottage cheese with mashed, water-
packed tofu mixed with a little lemon juice. If you’re choosing soy cheeses, read
the label to check the fat content and to see whether they’re made with added
casein, the dairy protein.
If you crave meat: Good substitutes for hot dogs, burgers, and deli meats
are now widely available. Seitan (made from wheat gluten), tofu, tempeh, and
textured vegetable protein are versatile products that substitute well for meat in
recipes. Surprisingly enough, the desire for meat fades very rapidly once it is
removed from the diet. People who thought they could not live without steak or
a salmon fillet soon find they have absolutely no desire for it.
Genetic Influences on Cravings
Although cravings can affect anyone, some people may be especially vulnerable.
Researchers have found that some people are born with fewer receptors for
dopamine, the brain chemical responsible for pleasurable feelings. Apparently,
this lack of receptors means that they get less dopamine stimulation and less of
the feel-good sensation that dopamine provides. This leaves them feeling a bit
out of sorts compared with other people. As a result, they are drawn to tobacco,
alcohol, or drugs; presumably, they are seeking the stimulation that nature has
not given them. They may even fall prey to compulsive gambling or compulsive
eating.
It all starts with a gene. The receptors for dopamine are built according to the
specifications on your chromosomes—the long spiral staircase–shaped strings of
genes in each of your cells that determine who you are. Your mother and father
passed along their genes to you, and the makeup of your body reflects the
combination of the two. If either parent passed along a gene for having too few
dopamine receptors, you would have roughly one-third fewer receptors than
other people.
If you were able to sample individuals in smoking cessation programs or
drug treatment clinics, you would find that as many as 40 percent have a gene
that causes them to have too few receptors, called dopamine receptor D2, or
DRD2 for short.
Several years ago, I found myself wondering if people who have trouble
following a healthful diet may have this genetic variation. Ernest Noble, MD, of
the University of California, Los Angeles, conducted genetic analyses on our
patients. To our surprise, we found that nearly half of our research participants
with type 2 diabetes had the gene that was associated with fewer than normal
dopamine receptors. That is far higher than the roughly one-in-five prevalence in
the general population.
This raised a disturbing question: Did the lack of dopamine receptors lead
them to overeat? Did overeating then lead to weight gain, which in turn triggered
diabetes? We have not yet sorted all this out, but we did find that while people
with this gene improved a great deal on our diet, they got somewhat less benefit
compared to those with the normal number of dopamine receptors. Their A1C
values dropped by about 0.9 percentage point on average, compared to a drop of
1.6 points for those without the gene. At present, this type of genetic testing is
done only in research studies. Your doctor cannot determine whether you are
genetically endowed with fewer dopamine receptors. In fact, as far as your food
plan is concerned, it does not matter. Regardless of your genetic makeup, the diet
described in this book is very likely to help you. I raise the issue of genetics
simply to underscore the point that cravings and food addictions are physical,
not moral issues. They are due to the properties of foods themselves that interact
with our natural biochemistry.
One final point: If certain foods act like drugs, it pays to treat them like
drugs. In other words, avoid them. Just as it is harder for a smoker to cut down
than to quit and harder for an alcoholic to drink wine moderately than to quit
drinking altogether, it is very tough to tease yourself with foods that have you in
their clutches. It is actually easier to leave them alone completely and do your
best to forget about them. If you have not had one of these biochemically active
foods in a few weeks, you crave it much less than you would if you had it
yesterday.
The brain cell at the top contains small packets (vesicles) of dopamine. When you experience a
pleasurable sensation, these vesicles release their dopamine into the space (synapse) that lies
between that cell and the next one. As the dopamine molecules reach the next cell, they attach to
its dopamine receptors, and their effect depends on how many dopamine receptors you have.
Some people have approximately one-third fewer receptors than other people.
DIGESTIVE PROBLEMS
A plant-based diet is great for people who have been bothered by constipation.
Its natural fiber is what your digestive tract needs. Some foods can cause a bit of
gassiness, however. If you experience this, here is what to do about it.
First, only certain foods cause gas. Grains, fruits, and most vegetables get a
not-guilty verdict. Beans and undercooked cruciferous vegetables (broccoli,
cabbage, cauliflower, and Brussels sprouts, for example) are the main culprits.
Chances are, all you need to do is have smaller servings. If you have been
replacing a huge steak with a huge plate of beans, remember that a small amount
of beans goes a long way. Try downsizing your portions.
Over time, you will find that your body adjusts, so you can have larger
portions with less gassiness. If you cook beans from scratch, be sure to discard
the water used to soak them and then cook them in fresh water. Cook them well
(there are no al dente beans)! The same goes for cruciferous vegetables. Yes, we
all love a stalk of fresh broccoli from the crudités tray, but if that gives you
digestive trouble, cook vegetables until you can easily pierce them with a fork.
It goes without saying that you want to avoid dairy products and sugar. Dairy
products, of course, are already off the list, but digestive problems are yet
another reason to steer clear of them, as you saw in Chapter 4. The lactose (milk
sugar) that makes up fully 55 percent of the calories in fat-free milk causes many
people to have gas, cramps, and diarrhea. Here is why.
During infancy, the lactase enzyme is produced within the body and breaks
lactose apart in the baby’s intestinal tract so it can be absorbed and used for
energy. As children leave infancy behind, however, most lose this enzyme. The
result, lactose intolerance, was once thought to be abnormal, but it is now known
to be the biological norm, not only for humans but for all mammals. Because the
body’s lactase production slacks off gradually, many people do not make the
connection between their digestive symptoms and milk products.
In about 85 percent of Caucasians, a genetic mutation causes the lactase
enzyme to persist well into adulthood. Even so, lactose intolerance will
eventually affect many of them, too. Deleting dairy products from the menu for a
few days will show you whether you are among them.
Some adults have trouble digesting table sugar (sucrose). Once again, it is
easy to check. Simply set it aside for a few days and see if your symptoms
improve.
HIGH TRIGLYCERIDES
When your doctor checks your cholesterol, triglycerides will also be listed on the
laboratory report. Triglycerides are molecules of fat that are transported in the
blood for various purposes. As with cholesterol, having a certain amount of
triglycerides in the blood is a normal part of human biochemistry. However,
when triglycerides are high, they increase the risk of heart problems, diseases of
the pancreas, and other problems. As you saw in Chapter 7, a normal triglyceride
concentration is less than 150 mg/dl. Values of 150 to 199 mg/dl are considered
borderline, and values of 200 to 499 mg/dl are high. Concentrations of 500
mg/dl or higher are considered very high.
Some studies have suggested that diets high in refined carbohydrates may
cause a temporary rise in triglycerides. High-fiber and low-GI foods appear to
have the opposite effect.
2
You will want to make a special point of favoring these
foods. In our research, a low-fat, low-GI, vegan diet brings down triglyceride
levels very effectively. In addition, a low-fat, vegan diet helps you lose weight,
which in turn reduces triglycerides.
Regular exercise helps, too. Moderate physical activity, such as walking,
lowers triglyceride concentrations. You will also benefit by avoiding alcohol.
Alcohol appears to raise triglycerides slightly, so when you avoid it, triglycerides
slide back down.
INTERACTION BETWEEN VEGETABLES AND PRESCRIPTION
BLOOD THINNERS
Warfarin (Coumadin) is a blood thinner prescribed to prevent heart attacks,
strokes, blood clots in the legs, and other problems. It acts by antagonizing the
effects of vitamin K, which is involved in building the proteins your body uses in
the clotting process.
Many people taking warfarin believe they have to avoid vegetables,
especially green leafy vegetables, that are rich in vitamin K because the vitamin
will affect their tendency to form clots. But avoiding these healthful foods would
leave them very low in important vitamins and minerals.
I encourage you to discuss this issue with your doctor and your dietitian, but
the answer is not to avoid vegetables. What matters is maintaining a fairly steady
amount of them in your diet so your warfarin dosage does not need to be
continually adjusted. If you eat lots of healthy vegetables and then suddenly
stop, warfarin’s actions become stronger, increasing the risk of bleeding. On the
other hand, if you were to generally avoid vegetables and one day suddenly
increase your intake, the vitamin K in these foods would have the opposite
effect, making it easier for your body to form clots. Bottom line: Enjoy
vegetables and keep the amount fairly constant from day to day.
By the way, alcohol increases warfarin’s effects, which is why doctors
encourage people taking it to avoid alcohol. Many medications (e.g., aspirin,
acetaminophen, and many others) can also accentuate warfarin’s action.
If you have hit any bumps in the road, I hope you have found these
suggestions helpful and that you are now back on track with a healthful diet.
CHAPTER 10
Which Supplements Should You Take?
News stories and advertisements trumpet the benefits of various nutritional
supplements. Drugstores and health food shops are stocked with shelf after shelf
of them. Which ones help, and which ones are unnecessary?
Here is some basic information that will help you decide. You should,
however, talk to your doctor, nurse practitioner, pharmacist, or dietitian about
which products you may take. You may have a particular need for one or another
supplement depending on your health. Or you may need to avoid certain
products because they interfere with medications you are taking.
If you are adding supplements that might affect your blood sugar, be sure to
check your blood glucose regularly. Refer to Chapter 7 for how to recognize and
treat low blood sugar.
Let’s look at specific vitamins and other nutritional compounds, starting with
the basics.
Vitamin B
12
. This vitamin is essential for healthy blood cells and nerve
function. If you follow a vegan diet, as I recommend, you should take a daily
vitamin B
12
supplement that provides at least 5 micrograms. Nearly all brands
contain more than this, but higher doses are not toxic. Many people, particularly
older people, tend to run low on vitamin B
12
regardless of their diets, because
their bodies become less efficient at absorbing it. That is also true of people
taking metformin or acid-blocking medications. Yes, you can find vitamin B
12
in
some fortified products, such as breakfast cereals and soy milk, but the amounts
may not be enough to meet your needs.
Vitamin D. Vitamin D is produced when your skin is exposed to sunlight. It
helps you absorb calcium, among other functions. It is a good idea to spend 15 to
20 minutes daily outdoors. If you get this sun exposure, there is no need for
dietary supplementation. If you do not and also do not take a regular
multivitamin, a 2,000 IU vitamin D supplement is a good idea.
Aside from the basic vitamins, some other supplements have shown promise
for people with diabetes.
Cinnamon. Cinnamon has been shown to improve blood sugar levels. As
little as ½ teaspoon of ordinary cinnamon added to your morning oatmeal or
other foods not only seems to reduce blood sugar, but also appears to reduce
blood cholesterol levels.
1
Some of cinnamon’s helpful effects may be explained
by compounds called polyphenol polymers, which are found in the spice and
have an insulin-like action.
Magnesium. In harvard’s Nurses’ health Study, women who had more
magnesium in their diets had a significantly lower likelihood of developing
diabetes.
2
Apparently, magnesium increases insulin sensitivity and may increase
the secretion of insulin from the pancreas, which suggests that it may also be
helpful after diabetes has been diagnosed.
This does not mean, however, that you need a magnesium supplement. Foods
rich in magnesium include whole grains (grains with their natural fiber intact)
such as brown rice, barley, and oats, as well as green vegetables such as spinach
and Swiss chard. Many bean varieties are also rich in magnesium.
Chromium. Chromium is an element that helps insulin work better, meaning
that it helps the hormone escort glucose from your bloodstream into your cells.
Technically speaking, chromium is what is called an insulin cofactor—an
insulin helper, if you will. In the same way that you cannot use a jack to lift your
car if its handle is missing, insulin has trouble bringing glucose into cells without
chromium to help it work properly.
Chromium’s essential role was discovered only relatively recently. In the late
1960s, researchers found that chromium deficiency could lead to high blood
sugar levels.
3
In 1977, Canadian researchers described the case of a woman in
her midthirties who was receiving all her nutrition intravenously following
intestinal surgery. As time went by, she began to lose weight. Her blood sugar
started to rise inexplicably, and eventually, she developed nerve symptoms in her
legs that appeared to be diabetic neuropathy. Her doctors had to administer large
insulin doses to bring her blood sugar under control. Eventually, they gave her
chromium, which had been absent from her feeding formula. In just a few
weeks, her blood glucose fell to the point where she no longer required insulin,
and her nerve symptoms disappeared.
4
Chromium is naturally present in many foods, such as broccoli, green beans,
whole grains, nuts, and even coffee. Some experts recommend taking
supplements as well.
Which foods have it, and how much do we need? According to the Food and
Nutrition Board of the Institute of Medicine, the safe and adequate daily intakes
of chromium for adults ages 19 to 50 are 35 micrograms for men and 25
micrograms for women. For people over 50, the amounts are 30 micrograms for
men and 20 micrograms for women. Here is the amount of chromium in
common foods, as listed by the US government.
Chromium Content of Common Foods
FOOD PORTION CHROMIUM (MCG)
Broccoli ½ cup, cooked 11
Grape juice 1 cup 8
English muffin, whole wheat 1 4
Potatoes, mashed 1 cup, cooked 3
Garlic, dried 1 teaspoon 3
Basil, dried 1 tablespoon 2
Orange juice 1 cup 2
Whole wheat bread 2 slices 2
Red wine 5 ounces 1–13
Apple, with skin 1 medium 1
Banana 1 medium 1
Green beans ½ cup, cooked 1
Source: National Institutes of Health, http://ods.od.nih.gov/factsheets/Chromium_pf.asp#h2,
accessed April 10, 2017.
While you are making sure to include chromium-rich foods in your menu, it
may also help to steer clear of sugar and refined grain products such as white
flour. These foods are not only low in chromium, they also increase chromium
loss from the body. Loss of the mineral is also increased by the stresses of
infection, strenuous exercise, and pregnancy.
Some researchers have gone beyond foods and have tested the effects of
supplements. However, studies in which researchers gave chromium to people
with type 1, type 2, or gestational diabetes have yielded mixed results. The
problem may be that some studies were small and used rather small chromium
doses, but some studies using higher doses in individuals with type 2 diabetes
have shown no benefit.
5
As a result, most diabetes authorities do not recommend
chromium supplements.
If you are going to supplement, you should be aware that the safety of high
chromium doses has not been as extensively studied as that of other minerals.
Studies using chromium for diabetes treatment often exceed the amounts
recommended by the US government, using doses of up to 1,000 micrograms per
day. Individuals with impaired liver or kidney function may be at risk for
adverse effects and should probably stay well below this level. The long-term
benefits and risks of chromium supplementation are not known.
Alpha-lipoic acid. Alpha-lipoic acid, sometimes called thioctic acid, is
naturally produced in the human body. It plays important roles in the
mitochondria, the microscopic “burners” that provide energy in the cells. It
works as a cofactor for several enzymes related to energy metabolism.
Supplemental alpha-lipoic acid is used not to counteract deficiencies but to
act essentially like a drug. In high doses, it acts as an antioxidant. In people with
type 2 diabetes, it appears to increase insulin sensitivity and reduce symptoms of
nerve damage.
6, 7
In many studies of alpha-lipoic acid, researchers used intravenous infusions
rather than oral doses. So far, it appears to be safe, but it is not yet clear whether
it will yield clinically important effects over the long run and if so, what doses
are safe and effective for long-term use.
For Further Reference
If you search for information about supplements on the Web, you may find
yourself carried away by a flood of commercial sites. I recommend this National
Institutes of Health site, cc.nih.gov/ccc/supplements.
CHAPTER 11
Exercise for the Rest of Us
Yes, exercise is good for you. Physical activity reduces your blood sugar and is
good for your heart. It improves the quality of your sleep and your overall
energy level. When you get into an exercise groove, you really feel great.
For many of us, however, exercise conjures up images of painful workouts
and unrewarding drudgery. Many people have trouble getting into an exercise
routine; it just does not seem to work for them. For every person I hear say
something like this:
“I feel so good when I exercise. I have more energy, my blood sugar
comes way down, and I just feel great. I can’t imagine a day without it.”
…there’s another who feels more like this:
“I really just can’t get into exercise. I know I’d do better if I did, but
every time I join a gym or resolve to start exercising, it just doesn’t last.”
If you are carrying around a lot of extra weight, exercise can be difficult.
Perhaps you are limited by joint pain or heart problems. Maybe your good
intentions just seem to vanish when the time comes to lace up your sneakers. In
this chapter, we will tackle the various aspects of exercise—its benefits, its
limitations, and the difficulties in getting started—and see how to make it work
for you.
One note of reassurance: If you cannot exercise because of a physical
limitation, you can still lose weight, cut your blood sugar, and live a healthy life.
In fact, most of the benefits of the diet changes you have read about came
without exercise. That is because in our diet studies, we usually ask our
volunteers not to alter their exercise patterns, so we can isolate the effects of a
diet change for research purposes. Exercise certainly adds to the health benefits
that a good diet brings, but if it is simply not in the picture, you can still do well.
WHAT YOU ARE WORKING FOR
Different kinds of exercise provide very different benefits.
Aerobic exercise is any sort of rhythmic, continuous activity you perform
for a sustained period—usually at least 10 minutes. Brisk walking, running,
playing tennis, dancing, or skating can all be aerobic. This type of exercise
reduces your blood sugar and triglycerides, and if you keep it up, you will live
longer.
Resistance exercise is weight lifting and other exercises in which the
emphasis is on muscular effort: pushups and deep knee bends, for example. It
builds your muscle mass or at least preserves the muscle you have. It also
improves insulin sensitivity.
Flexibility exercises (stretching) are intended to maintain the range of
motion of your joints. They can also relieve stress.
Below, I will give you guidelines for how much and how often you should
exercise.
A diet–exercise combination can help prevent diabetes from ever developing.
A groundbreaking study called the Diabetes Prevention program followed 3,234
people whose blood sugar levels were creeping upward but were not yet high
enough to warrant a diagnosis of diabetes. With a combination of diet and
exercise, the participants were able to cut the risk of developing the disease by
58 percent. The exercise regimen totaled 150 minutes per week—a half hour five
times a week.
1
There is a very big caveat with all of this, though: Exercise can boost the
effects of a healthy diet, but it cannot make up for a poor one. In fact, of the two
components—diet and exercise—the diet portion is much more important for
weight loss and ultimately for preventing or controlling diabetes.
A careful review of published research showed that people who begin
exercise programs do not lose much more weight than people who remain
sedentary.
2
For weight control, exercise cannot take the place of diet changes.
This does not mean that exercise is of no help at all. It is definitely helpful
for reducing A1C. In a review of several studies testing the effect of exercise, the
average A1C in volunteers who began exercise programs fell to 7.7 percent,
which is better than the 8.3 percent found in those who did not exercise.
3
Once
again, however, that result pales in comparison to the benefits of a diet change.
To prevent diabetes or bring it under control, it is best to use both diet and
exercise.
one part of your body that benefits tremendously from exercise is your heart.
A recent study tracked physical activity levels in adults with type 2 diabetes over
a period of 19 years and looked specifically at the risk of dying of heart disease.
It turned out that those who were moderately physically active were about 40
percent less likely to succumb to heart disease than were sedentary people. Their
routines included at least 4 hours per week of moderate exercise such as
walking, cycling, or light gardening.
4
Active people also cut their risk of stroke.
5
There are three other exercise benefits worth noting. First, exercise and
eating are mutually exclusive activities. It is easy to scarf down extra calories
while watching your favorite crime drama or a movie, but it is a real challenge
while you are playing tennis. Exercise is calorie-free fun.
Second, exercise helps you sleep. If you have given your muscles a good
workout, they demand sleep. You will sleep much more soundly than if you had
spent the entire day behind your desk, watching television, or reading. And when
you are well rested, it is easier to stay focused on a healthy diet and say no to
unhealthful foods.
Third, exercise makes you feel better. It lifts your spirits and is a natural
antidepressant.
TYPE I AND TYPE II MUSCLE CELLS
Why do some people love exercise and others loathe it? Surprisingly enough,
part of the reason is genetic. If you could look inside your muscles and compare
them with those of other people, you would discover a sobering fact: Some
people were born to exercise. That is to say, their muscles naturally contain
many type I cells (the name has nothing to do with type 1 diabetes; it is just a
coincidence). These muscle cells have a particularly strong blood supply made
possible by a rich network of capillaries that bring in oxygen and reduce fatigue.
They also have an extra supply of an enzyme called lipoprotein lipase, which
breaks fats apart to be used as fuel. The result is extra energy for a long run.
When you see people running down the road looking invigorated rather than
haggard, or when someone waxes poetic about the joys of the runners high, do
not envy their resolve. Odds are, they were born with muscles that are just
loaded with type I cells.
Other people’s muscles contain mostly type II cells, which are fine for short
bursts of exercise but have less endurance for the long haul.
Now, having said that, it is important to realize that muscles can change, at
least to a degree. If you gradually but steadily increase the intensity of your
workouts (within the limits of safety), the blood supply to type II cells increases.
Eventually, they become almost as vigorous as type I cells.
I raise this biological distinction to make an important point: Exercise
aptitude—or lack of it—is not a question of character; it is biology at work. If
you have been beating yourself up for your lack of athletic prowess, it is time for
a reprieve.
MAKING IT WORK FOR YOU
There are two keys to making exercise work.
First, let’s keep it fun. For most of us, that means it should be a social event.
It is more fun to go walking with someone else than by yourself. If you plan to
exercise at a gym, you are much more likely to follow through if you sign up for
a class—aerobics, yoga, or whatever—than if you go it alone. You are also much
more likely to actually get to your class if someone is going with you.
You might make an occasion of it and plan an especially healthful meal
afterward. If you are going dancing or playing tennis, the word exercise may not
even enter your mind. Your activity is too enjoyable to call it that. Keep it fun
because otherwise, you will not do it twice, much less three times a week. And
for most people, fun means friends. You need other people with you to make it
work.
Second, it is important to exercise regularly rather than intermittently. To
paraphrase Newton’s first law of motion, “an object at rest tends to stay at rest,
and an object in motion tends to stay in motion.” If the object at rest is you—that
is, if you are firmly planted on the couch—you will tend to stay at rest. If, on the
other hand, you and a friend go for a walk every other day after dinner, you will
stay on track.
One important tip: As you get ready for an exercise session, you will have
some misgivings. The little devil on your shoulder will tell you that you are too
tired, you don’t have time, you just don’t feel like it, etc. But the fact is, you will
never feel like it right at that “getting ready” moment. So don’t wait for that
perfect day when you will “feel like it.” Just do it anyway, and do it now. Get on
out there and do your thing. And very soon, you’ll discover that you are glad you
did.
This cycle will repeat itself every time you exercise—feelings of misgivings
and negative thoughts, followed by your resolve to just ignore that negativity
and do it anyway, followed by being so glad that you did. And before long, your
confidence will grow and you’ll get into a groove.
There is another reason for keeping exercise regular: The effect of any single
exercise session is small. If you belong to a gym, you can see this for yourself.
Just jump on the nearest treadmill and run flat out for a mile. Then, as you catch
your breath, push the little button that lets you see how many calories you have
burned. Surprised? That’s right, you have expended only about 100 calories.
That’s less than half the calories in an order of McDonald’s french fries or a
bottle of soda. A single exercise session every now and then will not help you
any more than occasionally eating a healthy meal. To be really effective, healthy
habits have to be part of your routine.
Also, for better or worse, exercise effects do not last very long. If you are
laid up with an injury, for example, you will find your blood sugar or weight
gradually returning to its pre-exercise level. People who get into a habit of going
for a brisk walk or bicycle ride every day or two sustain their benefits.
Bottom line: To make exercise work, keep it fun, and keep it regular.
SEE YOUR DOCTOR FIRST
Before you embark on a new exercise program, be sure to get your doctors
okay. Is your heart up to it? Are your joints ready? How vulnerable are you to
hypo- or hyperglycemia? Do you have any special eye or foot problems that
could be aggravated by exercise? Your doctor should address all of these
questions.
Beware of jumping into vigorous exercise too quickly. If it has been months
(or years) since you tried exercising regularly, start slowly. It takes time for your
body to reap the rewards of your new, improved diet. A heart patient, for
example, who begins a vegan diet, stops smoking, and starts really taking care of
himself will probably feel better very soon. His chest pain may melt away within
a few weeks, and he will be eager to jump into a vigorous exercise program. The
fact is, though, that he still has the artery blockages he has been accumulating for
years. Yes, the damage can be reversed, but it takes time, and he should not push
himself past the limits set by his doctor.
If you have type 1 diabetes, you may find that your blood sugar drops
precipitously during and after exercise. This can also happen to people with type
2 diabetes who use insulin or drugs that cause insulin secretion (e.g., glyburide,
glipizide, glimepiride, nateglinide, or repaglinide). It is important to be alert to
the possibility of a major blood sugar drop and to adjust your eating schedule,
medication use, and exercise accordingly.
Occasionally, the opposite can occur: You may find that your blood sugar is
temporarily higher after exercise than it was before.
A research team based in Florida tracked blood glucose in children with type
1 diabetes as they walked on a treadmill in four 15-minute bouts, with 5-minute
rest periods in between. Their average blood glucose was 159 mg/dl when they
started, and it fell to 112 mg/dl afterward. At least one-quarter of the children
became hypoglycemic during or right after the exercise. They were also more
likely to be hypoglycemic during the following night.
6
Exercise can reduce your blood sugar surprisingly quickly. Of course, if you
eat too much in an effort to prevent hypoglycemia, your blood sugar can go too
high.
For these reasons, it is important to speak with your caregiver about your
medication, diet, and exercise program to make sure you are ready for exercise,
then make whatever adjustments are needed for safety.
GETTING STARTED
Okay. Your doctor has given you the green light, you have rustled up some
friends, and you are ready to begin.
If you were imagining that I would push you into hours of jogging and
weight lifting and harangue you with exhortations about “no pain, no gain”—
well, push those thoughts aside. The goal is to enjoy exercise—so much so that it
becomes part of your life.
For aerobic exercise, I suggest starting with a half-hour brisk walk 5 days a
week, assuming that you have no health-related exercise restrictions. If you
prefer, you can exercise three times per week, either taking brisk 1-hour walks or
doing more vigorous half-hour workouts. You can also break up those 30-minute
walks into 10- or 15-minute mini-workouts if you like. Do not allow yourself
more than 2 sedentary days in a row. The benefits of walking are not as great as
those of a more vigorous exercise program, but it is a good place to start.
The important thing is to find a time that works for you.
It is a good idea to put exercise on your schedule, as if it were an
appointment with yourself, and to include someone else in your plans.
A pedometer will help you keep track of your progress. In our research
studies, we use an Omron pedometer to track the total number of steps
participants take each day as well as the number of “aerobic steps” (steps taken
as part of a continuous walk of at least 10 minutes). The participants can also
program in their stride length to track mileage and even estimate their calorie
burn. Take note of how many (or how few!) steps you take in a normal day, then
gradually increase them. For reference, 10,000 steps or more is a vigorous day
for a healthy person, but you may not have the strength or stamina to do that
many. Do not push beyond your doctors recommended limits.
A podiatrist or nurse specializing in diabetes (certified diabetes educator, or
CDE) will help you take care of your feet. This is important since exercise can
sometimes cause foot injuries or aggravate an existing injury. It is surprising how
often people are unaware of gradually worsening foot sores.
Your doctor will help you gauge your improvement and can advise you about
increasing your exercise intensity. As your endurance improves, you will find
that your energy just keeps increasing, and your weight and blood sugar stay
under better control.
What’s Your Pleasure?
Taking a regular walk is a great way to start exercising. When you are ready to
add other activities, think about which ones you might enjoy.
Aerobics classes can be fun, social, and sometimes intense.
Dancing is wonderful exercise, with better music than most aerobics classes.
Tennis, either singles or doubles, can be a great workout.
Many health clubs organize racquetball or handball lessons and
competitions.
Golf can be great exercise if you walk the course.
Local running clubs often organize training groups for people working
toward 5-K, 10-K, and half- and full-marathon races.
For resistance and flexibility exercises, I suggest that you work with a
personal trainer, both for safety reasons and to individualize your program using
the right equipment. Professional athletes are not the only ones with access to
professional fitness expertise; you can have it, too. A personal trainer can help
you plan a full program, not only for aerobics but also for strength training and
flexibility.
most health clubs have trainers on staff and may even offer a free session as
an incentive to join. Why not take advantage of it? If you do not plan on joining
a gym, just make an appointment for a single exercise counseling session so you
can get a program that is right for you. Then schedule a follow-up.
No Blame, No Shame
With exercise, just as with diet, most people are not yet where they would like to
be. Guilt and blame come into the picture when we are sedentary, just as they do
when we are not eating well. Sometimes family members try to scold us into
exercising, and sometimes doctors try the same approach. But all their
moralizing is nothing compared to the guilt-laden punishment we heap on
ourselves, as if not exercising were a tremendous moral failing.
If that is where you are, let me encourage you to set guilt and blame aside.
Just let it all go. Tell your guilt-inducing friends that up until now, you have been
illustrating Newton’s first law of motion. Now, however, you are about to get
into gear and explore the second part of that principle.
The same applies if you happen to fall off the wagon. Let’s say you have let
your exercise regimen lapse for a bit—maybe even a very long bit. Do not waste
your time feeling bad about it; it happens to everybody. Just dust yourself off and
get back on.
When exercise is fun and your friends or family are part of it—and when you
start at a level that’s right for you and keep it regular—you have the formula for
success.
PART 3
Complete Health
CHAPTER 12
A Healthy Heart
Managing or reversing the effects of diabetes means more than getting your
blood sugar under control. It also means regaining your health as much as you
possibly can, and safeguarding it.
If you have been in poor health—or if diabetes has attacked your heart, eyes,
kidneys, and nerves—revamping your diet can have a dramatic positive effect on
your well-being. In this chapter and the next, we will look at how to keep your
heart—and the rest of you—healthy.
TAKING RISK SERIOUSLY
You probably already have a good idea of your risk of heart problems. Your
doctor has sized up your cholesterol level and blood pressure, and you know
your family history. You may be on medications to control cholesterol or
strengthen your heart.
The next step is to review what you need to know about risks, and more
important, to see what you can do to prevent heart disease and, if necessary,
reverse the disease process.
In evaluating your risk of developing heart problems, doctors look at your
age, family history, smoking habits, weight, cholesterol level, blood pressure,
and other factors. I believe, however, that it is prudent to act as if you are at risk
even if none of these factors apply to you. Here is why: Most people in North
America and Europe have already developed artery blockages—the beginnings
of heart disease—by the time they reach early adulthood. Having diabetes
increases that risk. Rather than wondering, “Am I at risk?” it is safe to simply
assume that you are—and to take action to protect yourself.
Some evidence suggests that your heart is assaulted especially hard by
smoking, high blood pressure, and high cholesterol levels, while your small
blood vessels, such as those in your eyes and kidneys, are especially sensitive to
high blood glucose levels. That is probably true, although all of these risk factors
matter for both types of complications.
SIZING UP THE ENEMY
let’s take a minute to understand the dragons we are slaying, starting with
cholesterol.
Your body uses cholesterol in the same way a factory might use petroleum.
Cholesterol is a raw material, and your body makes many things from it. Believe
it or not, cholesterol is used to make certain hormones, including testosterone
and estrogen. It is also inserted into the thin cell membranes that surround each
cell in your body, and it acts as a kind of glue to hold the membranes together.
Without it, you would collapse into a gelatinous heap.
Just as refineries send trucks filled with petroleum to factories to be turned
into everything from plastic to petroleum jelly, your liver sends particles
containing cholesterol into your bloodstream for your cells to use.
Imagine what would happen if a refinery flooded the roads with tankers,
sending out far more supply than was needed. Day after day, more and more oil
trucks would clog up the roadways. Some might have accidents, spilling cargo
and creating havoc.
Cholesterol presents the same problem. When too many particles of
cholesterol pass through your bloodstream, they create a different kind of
congestion.
The circulating particles can easily become damaged. When they do, they
spark the formation of raised bumps called plaques, which are very much like
small scars on your artery walls.
Now, this is dangerous, because plaques are fragile. They can crack or
rupture, and when that happens, the blood around the plaque starts to clot. The
growing clot can fill the artery like a cork and stop blood-flow. If that happens in
an artery that carries blood to the heart, a portion of heart muscle will die. That’s
a heart attack, which doctors call a myocardial infarction.
The solution to the problem is to reduce the number of cholesterol particles
circulating in the bloodstream. Luckily, we know how to do that. Although
previous diets had only a modest ability to lower cholesterol, the diet changes
described within the pages of this book are dramatically effective.
Is It My Genes?
Rick was 45 when he came to our office looking for help. He was not terribly optimistic that a
diet change could really help him. His father had had diabetes and heart disease, and his own
cholesterol had been high for years. Previous diets had let him down. A few years earlier, his
doctor had suggested limiting red meat and eating more fish and chicken, but the change had
had no perceptible effect. “I must have a genetic problem,” he said.
It may well be that genes played a big role in his problem, I told him. But we would not know
that until we made a more serious effort to change his eating habits—one that went beyond
what he had tried before.
I explained to him what you are reading in this chapter. He decided to give it a try. (His story
continues in the box “Jumping Into Oatmeal.”)
REVERSING HEART DISEASE
The most famous program using diet and lifestyle changes to tackle cholesterol
and reverse heart disease was developed by Dean ornish, MD, at the Preventive
Medicine Research Institute in Sausalito, California.
Dr. Ornish is a Harvard-trained physician who made medical history in 1990
by showing that a combination of diet and other lifestyle changes could actually
reverse artery blockages. His findings were published in the Journal of the
American Medical Association, Lancet, and other prestigious journals.
In his landmark study, Dr. Ornish recruited heart patients from hospitals in
the San Francisco area and divided them into two groups. Participants in one
group—the control group—were asked to follow their regular doctors’ advice
about diet and other treatments. Generally speaking, that meant a diet favoring
chicken and fish rather than red meat, cutting back on fat, and using medications
as needed.
The other group—the experimental group—was given a very different
regimen. They did not use cholesterol-lowering drugs at all. Instead, they began
a very special diet. First, because cholesterol is found in animal products (meat,
dairy products, and eggs), Dr. Ornish chose a vegetarian diet for the study.
Remember, grains, beans, vegetables, fruits—in fact, all plant-derived foods—
are essentially cholesterol-free.
These foods are also free of animal fat, which is even more important. Just to
clarify, cholesterol and fat are two different things. Cholesterol is a microscopic
ingredient in cell membranes, as described above, and is present in all animal
cells.
Fat is different. It is the white strip in a cut of roast beef, the yellow layer
under chicken skin, and the greasy residue left on your fingers if you touch a
salmon fillet. You can easily see and feel animal fat. When you eat it, your body
makes cholesterol.
I learned about animal fat as a child growing up in North Dakota. Some
mornings, my mother cooked bacon for my four siblings and me. When it was
done, she put the hot strips on paper towels to drain. She then carefully picked
up the frying pan and poured the hot grease into a jar to save it. Now, she did not
store the jar of bacon grease in the refrigerator; she simply put it in the cupboard.
She knew that as it cooled, it would turn into a waxy solid. The next day, she
spooned some of the bacon grease into a pan and fried eggs in it. With that sort
of diet, it is perhaps remarkable that any of her children lived to adulthood, but
that is the way we ate until we learned better.
The fact that bacon grease is solid at room temperature is a sign that it is
loaded with saturated fat, which you can think of as “bad” fat, because it raises
your cholesterol level.
*
All fats are mixtures. Beef fat, for example, is about half saturated fat, with
the rest being a mixture of various unsaturated fats. Chicken fat is about 30
percent saturated fat. Fish vary from about 15 to 30 percent saturated fat.
Vegetable oils are much lower in saturated fat, except for the tropical oils:
Coconut, palm, and palm kernel oil are all high in saturated fat.
Some food companies alter vegetable oils through a process called
hydrogenation, which makes them similar to saturated fats. The resulting fats,
called trans fats or partially hydrogenated fats, are solid and have a long shelf
life. Unfortunately, their effect on your cholesterol level is similar to that of
butter or lard. They are sometimes used in restaurant fryers and in snack foods.
When you see the words partially hydrogenated vegetable oil on a food label,
it’s a good idea to move along to a healthier choice.
You can see why Dr. Ornish decided to use a vegetarian diet in a program of
healthy lifestyle changes. Plant foods have essentially no cholesterol and no
animal fat. He also kept vegetable oils to a minimum.
The results were remarkable. Among the vegetarians, chest pain rapidly
melted away. The average person’s LDL (“bad”) cholesterol fell by about 40
percent. After a year, each participant had an angiogram—a special x-ray that
shows blockages in the arteries of the heart—and Dr. Ornish compared the
results with those of the same kind of test done at the beginning of the study. The
results were amazing: The blockages in the coronary arteries—the arteries that
nourish the heart muscle itself—were actually starting to shrink. The arteries
were opening again. The effect was so pronounced that the difference could be
clearly seen on the angiograms of 82 percent of patients after the first year—all
with no heart bypasses, no angioplasties, and not even cholesterol-lowering
drugs.
WAKE UP AND SMELL THE CHOLESTEROL
By now you are probably yawning, saying you already know that cholesterol and
saturated fat are bad and that we’re supposed to cut down on them. “Been there,
done that,” you say.
Well, that is exactly the problem. For years, health authorities have suggested
that people “cut down” on foods containing cholesterol and animal fat. Many
people have chosen “leaner” cuts of beef and favored chicken and fish, but they
have gotten very little in the way of results. Most people find that despite these
diet changes, their cholesterol levels barely budge at all, and many have decided
that diet changes are a waste of time. They conclude that their problems are
genetic and give up on their diets.
It turns out that a switch from red meat to white meat is just not good
enough. And here’s why: All meats—even “lean” meats—contain cholesterol,
ranging from about 10 milligrams in every ounce of tuna to about 50 milligrams
per ounce of shrimp. Chicken and beef are in between, with about 25 milligrams
per ounce. And yes, cholesterol in foods does pass into your bloodstream.
Despite the egg industry’s efforts to convince scientists and the public that
“cholesterol in foods does not affect how much cholesterol is in your blood,” the
fact is that cholesterol in foods does indeed raise blood cholesterol. Red meat,
poultry, and fish—even the “leaner” cuts—also contain a significant amount of
fat. And saturated fat causes your body to make cholesterol.
In contrast, of course, there is no cholesterol or animal fat in any food from
plants. That goes for every fruit and vegetable; every bean; every grain; every
variety of rice, pasta, and potato; and everything made from them.
Thus, if you were to try to lower your cholesterol by simply switching from
beef to chicken and fish, you would have one arm tied behind your back. As
shown in clinical tests, the cholesterol-lowering effect of a switch from red meat
to white meat is minimal—only about half the effect of a plant-based diet. Most
people who follow such diets have no measurable improvement within their
arteries, either—on average, their artery blockages continue to get worse as time
goes by.
WHY DIDN’T ANYONE TELL ME?
When Dr. Ornish’s findings were published, most medical authorities were
willing to believe his program was a very healthful regimen. But many felt the
program was so austere that few people could actually follow it. I have studied
that issue in some detail, however, and have come to a completely different
conclusion. The diet is not terribly austere. In fact, it stacks up well against any
other diet a doctor might prescribe. Let me describe my own experience.
When I was growing up in cattle country, my family ate pretty much the
same things every day: roast beef, baked potatoes, and corn—except for special
occasions, when we ate roast beef, baked potatoes, and peas.
In medical school, I decided to change my diet. At first, I tried pasta, making
a sauce from fresh tomatoes, basil, and spices. Then I discovered that just below
the beef, poultry, and fish choices, Chinese restaurant menus feature many
delicious vegetable dishes, as do Mexican restaurants. Japanese restaurants serve
delicious miso soup, salads, and vegetable sushi. Middle Eastern cuisine is
simple but delicious, with hummus, falafel, couscous, and other delights. Thai,
Indian, Ethiopian—all these cuisines offer endless vegetarian choices. Compared
to those elegant meals, my North Dakota roast beef, baked potato, and corn no
longer seemed like the pinnacle of the culinary art. To me, a plant-based diet was
a world of new tastes and was anything but austere.
When I first learned about the work of Dr. Ornish in the late 1980s, I was
working at the psychiatry clinic at George Washington University. I telephoned
him and suggested that we study the acceptability of his diet. I flew to San
Francisco and interviewed each of the participants in his heart study.
1
I asked
how well they liked the foods they ate, how much effort was required to prepare
them, what their family members thought, and what they planned to do in the
future.
I found that the vegetarian group did grumble a bit at first. They had to learn
about some new foods and master some new cooking tricks. On average, it took
about 4 weeks before the diet really became second nature to them. But they
adapted well, partly because they saw such dramatic results. Their cholesterol
levels plummeted, their chest pain disappeared, and their heart disease reversed.
The average participant lost, believe it or not, 22 pounds during the first year.
2, 3
They came to love the foods they ate.
I vividly remember one participant’s reaction. He was angry—angry that
previous doctors were eager to prescribe potentially dangerous drugs and even
operate on him, charging him enormous amounts of money, and did not bother to
even mention the power of diet changes. Overall, the participants not only found
their diets acceptable, they felt it would be wrong for doctors not to give patients
this kind of choice.
Now, it did not surprise me that the vegetarian diet took a little getting used
to, or that the patients soon came to love it. What surprised me was the reaction
of the control group—the group that was not asked to adopt the vegetarian diet.
They grumbled, too. Some said their diet was nothing but chicken and fish,
chicken and fish, chicken and fish, night after night. All the pleasures of life
were gone, some said. And they had nothing to show for it. Many were still
dealing with chest pain, trying to control their cholesterol levels with
medication, and fighting a losing battle.
Having repeatedly studied how people react to different diets, I am
convinced that a vegan diet is actually easier to follow than most other diets.
This is partly because of its simplicity. Like quitting smoking or freeing yourself
from any other habit, setting aside unhealthy foods is easier than teasing yourself
with small amounts of them day after day. And the diet’s benefits are usually so
rewarding that you want to stick with it.
A few years later, I reviewed every published research study in which heart
patients were asked to change their diet, with researchers tracking their success
or failure.
4
At the time, the prevailing wisdom was that doctors should not push
their patients too hard to make diet changes because the patients were likely to
just throw up their hands and give up. But I found just the opposite. In controlled
studies, when researchers asked patients to make small diet changes, they in fact
achieved only small changes. When researchers encouraged their study
participants to make bigger diet changes, most participants actually did make
them, and they got better results. You can do it, too. Your heart deserves the very
best.
AIMING TO BE HEART ATTACK–PROOF
let’s leave Dr. Ornish’s California research center and take a short trip to Ohio to
meet Anthony Yen. He grew up in China, where his family members routinely
lived to a ripe old age. For them, heart disease, weight problems, diabetes,
cancer, and high blood pressure were virtually unheard of. They dined on rice,
noodles, and vegetable dishes of various kinds and used meat as no more than a
flavoring, the way some might use bits of onion, garlic, or pine nuts.
In 1949, as a young man, Anthony moved to the United States and slowly
gave up his traditional Chinese diet in favor of an American one. As the years
went by, he gradually gained weight, like many of his American friends, and he
started to develop heart problems, which steadily worsened. Ultimately, he
needed surgery—a quintuple heart bypass.
Then he was lucky enough to join a program for heart patients run by a
surgeon at the Cleveland Clinic. Caldwell Esselstyn Jr., MD, aimed to get
cholesterol levels so low that heart disease would stop in its tracks. He
prescribed a vegetarian diet without dairy products or added oils. He showed
patients how to cook and even occasionally hosted group dinners that featured
home-cooked foods. He added medications only if a patient’s cholesterol level
did not fall below 150 mg/dl with diet alone.
The program worked. Dr. Esselstyn’s patients became practically bulletproof.
Although they were in bad shape when they arrived, no one who adhered to the
program had any sort of recurring heart problem.
5
Anthony’s cholesterol level
improved dramatically. He lost weight and felt better than he had in years.
In the ensuing years, Dr. Esselstyn called American cardiologists together for
the Summit on Cholesterol and Coronary Disease. He put forward his belief that
physicians need to promote healthier diets. If doctors continue to prescribe only
modestly effective diets, he said, their patients will be stuck with endless
prescriptions, operating rooms will remain busy with angioplasties and coronary
bypass surgeries, and medical costs will continue to soar.
Dr. Esselstyn was right, as Anthony Yen, his other patients, and a growing
number of physicians can attest.
SPECIAL-EFFECT FOODS
By now, you know which foods to avoid. By skipping animal products and
added oils, you will sidestep cholesterol and the fat that can drive cholesterol
levels up. Of course, you want to avoid these foods anyway in order to improve
diabetes.
There are foods you might want to add to your diet, though, because they can
actually lower your cholesterol or protect against the damage that cholesterol can
cause.
Oats, beans, and barley contain soluble fiber that reduces cholesterol
levels. You have no doubt heard that oatmeal and other oat cereals have this
effect, and they have become popular for exactly that reason. But do not
forget the cholesterol-lowering power of the humble bean, which also
contains soluble fiber. Eating a serving of beans every day cuts cholesterol
levels significantly. Soluble fiber is also found in many vegetables and fruits.
Soy products have a special cholesterol-lowering effect. Aside from the fact
that they have no cholesterol or animal fat, there is something about soy
protein that brings down cholesterol a bit further. If your burger is made of
soybeans instead of beef, you will not only skip beefs cholesterol and fat,
you will also get an extra cholesterol-lowering benefit.
6
Certain nuts, such as almonds and walnuts, lower cholesterol, too. Yes,
they are as high in fat as other nuts, but somehow they have an ability to
reduce cholesterol levels that has not been fully explained. In studies, eating
3 ounces a day for 4 weeks has shown a measurable effect.
7
I do not
recommend that you make nuts a regular part of your diet, however. Despite
their cholesterol-lowering effect, they are so fatty that they will make weight
loss difficult and may interfere with your efforts to improve insulin
sensitivity.
Some margarines incorporate natural plant stanols or sterols that work
almost like drugs, blocking the absorption of cholesterol from the small
intestine. Benecol Light spread, for example, contains plant stanols derived
from pine trees mixed into a spread made with canola and soybean oils (see
benecol.com). You can use it in baking and frying if you like. It is not a low-
calorie or low-fat spread, though; 1 tablespoon has about 50 calories. Like
nuts, margarines can interfere with your weight-loss efforts.
Fruits and vegetables are not only cholesterol free and very low in fat; their
beta-carotene, vitamin C, and vitamin E can actually reduce the damaging
effects of cholesterol in your blood. Here’s why.
As cholesterol particles glide along in your bloodstream, those that enter
artery walls and cause plaque buildup are the ones that have become slightly
damaged, or oxidized. Beta-carotene, vitamin c, and vitamin E actually
protect the cholesterol particles from damage so they go on their merry way
without harming you.
You will find huge amounts of beta-carotene in orange vegetables, such
as carrots, sweet potatoes, and pumpkins, but there is also plenty in green
leafy vegetables. Vitamin C is in citrus fruits, of course, but also in many
other fruits and vegetables. And whole grains, vegetables, and beans are
healthful sources of vitamin E.
At the University of Toronto, Dr. David Jenkins took this approach to its
ultimate conclusion. He reasoned that if a vegan diet (that is, one with no meat,
dairy products, or eggs) lowers cholesterol levels; if soluble fiber, such as that in
oat bran, lowers cholesterol; if certain nuts lower cholesterol; if soy products
lower cholesterol; and if plant sterols lower cholesterol, then what would happen
if he prescribed them all at the same time?
He devised what he called a portfolio Diet, which included all of these
elements, and found that the combination led to a 29.6 percent drop in LDL
cholesterol in just 4 weeks, which was similar to the effect of cholesterol-
lowering drugs.
8
CONTROLLING CHOLESTEROL STEP BY STEP
Let’s summarize what research tells us about the ideal cholesterol-lowering diet.
Here are the keys.
1. Skip animal products. You will want to avoid meat (that means no red
meat, no chicken, and no fish), dairy products, and eggs. Avoid them entirely,
and you will eliminate all the animal fat and cholesterol from your diet. You
already know this is important for diabetes, and it is just as important for your
heart.
2. Keep vegetable oils to a minimum. To trim the oil from your diet, skip
the oily dressings, fried foods, and foods prepared with extra oil. Read the labels
on packaged foods. If you spot animal products or partially hydrogenated oils in
the ingredient list, you will want to avoid that food. And if there are more than 2
to 3 grams of fat in a serving, skip it.
3. Add special-effect foods. The best of these are oats, beans, and soy
products. They are filling but modest in calories, and they really do bring your
cholesterol down. It is easy to add special-effect foods to your routine.
Oats: Start your day with a bowl of old-fashioned oatmeal. Top it with
cinnamon if you like, but skip the milk and sugar or use soy milk.
Beans: Like oats, beans are high in soluble fiber, which lowers cholesterol.
Baked beans, black beans with salsa, pinto beans wrapped in a tortilla—all
are loaded with soluble fiber, protein, and all-around good nutrition. The
humble bean has even become quite chic, with some growers specializing in
beautifully colorful heirloom varieties.
Soy: It is easy to bring soy milk into your routine. You will also want to
learn about the many other forms of soy: low-fat tofu, tempeh, and many
others. Some people are a bit tentative about tofu until they taste it properly
prepared, then they come to love it. For all soy products, read the labels and
choose those lowest in fat.
With these changes, most people can expect to see major results. Diets that
eliminate cholesterol and animal fat (vegan diets), keep oils low, and use special-
effect foods typically achieve a big reduction in “bad” cholesterol.
4. If you are overweight, follow the weight-loss guidelines described in
Chapter 6. Each pound you lose cuts your total cholesterol slightly.
9
The effect is
gradual but important.
5. Exercise. When your doctor gives you the green light to exercise, you will
find it enormously helpful. Exercise will not lower your total cholesterol, but it
will increase HDL cholesterol, and that may improve your overall health profile.
Regular exercise (taking a brisk 30-minute walk five times a week or a 1-hour
walk three times a week) also helps keep your blood pressure under control.
Work with your doctor to set exercise goals based on your current health (see
Chapter 11).
Jumping Into Oatmeal
Rick, whom you met earlier, did very well with his diet changes despite his initial reservations.
He learned how to make a quick and hearty vegetable soup from a dried soup mix to which he
added tomatoes, cucumbers, sweet potatoes, and whatever other vegetables he had on hand.
He often cooked pasta and usually used marinara sauce from a jar for convenience. He also
included plenty of salads and cooked vegetables. Eating out was a challenge for him until he
discovered that international (Italian, Chinese, Japanese, Mexican, Thai, etc.) restaurants had
plenty of options. Speaking up helped, too—most restaurants gladly made him a vegetable
plate when he asked for it. He figured out which fast-food restaurants had veggie burgers or
salad bars and where he could get a respectable bean burrito.
He took a shine to what he called fake meats—bologna, ham, and other deli slices made of
soy protein—which he used in sandwiches with sliced tomato, lettuce, and Dijon mustard.
Sometimes he had a simple meal of beans and rice or a packaged rice dish (curried rice, rice
pilaf, etc.). He also became quite fond of couscous. For breakfast, he jumped into oatmeal,
figuratively speaking, and kept bananas and other fruits on hand both at home and at work.
While he found the diet surprisingly easy, he ran into a stumbling block at the beginning. He
served himself modest portions and resisted going back for seconds. As a result, he often felt
hungry. The fix: He simply ate more. On another occasion, he took my advice to eat beans a bit
too far and had an episode of gastric distress. He cut back on his bean serving sizes for a bit
and was fine.
His wife joined him in adopting a vegan diet. In the process, she lost a substantial amount of
weight and had more energy than she had had in years.
By the time Rick came in for his follow-up blood test, he had totally adapted to the diet, and
he was thrilled with the results. In 3 months, his cholesterol had dropped from 210 to 145, with
an LDL of well below 100. And this was the same man who had started out saying what he
really needed was different genes. “You know, this isn’t a diet,” he said. “This is a way of living,
and it just feels right to me. I’m never going back to the way I used to eat. This is it.”
SIZING UP YOUR PROGRESS
It is easy to see if the program is working. Follow it carefully, and after about 8
weeks, ask your doctor to check your cholesterol level. If you have not quite
reached the goals you set for yourself, take a close look at what you have been
eating. How well have you followed the program? If you really did follow it
carefully and your cholesterol failed to budge, you are probably one of those
uncommon individuals whose genes really are driving up their cholesterol levels.
If diet alone proves insufficient, follow your doctors advice, which may
include cholesterol-lowering medications. Some doctors believe that medications
have value even when cholesterol levels are normal. Research is under way to
test this possibility.
WHAT ABOUT “GOOD” CHOLESTEROL?
The cholesterol in high-density lipoprotein (HDL) particles is called “good”
cholesterol for only one reason: It is on the way out of your body. HDL particles
scour your artery walls, picking up cholesterol and eliminating it, like tiny
sanitation trucks carrying away garbage.
When people begin low-fat vegan diets, their HDL levels sometimes fall
slightly. But that is not a reason to worry—your LDL (“bad”) cholesterol level is
likely to fall much more. In fact, some people say that, since you have less
“garbage” in your bloodstream (that is, less LDL cholesterol), you don’t need so
many “garbage trucks” (that is, HDL cholesterol) to haul it away.
REDUCING TRIGLYCERIDES
Triglycerides is a technical term for fat in the bloodstream.
*
lowering
triglycerides is a good idea, as it will reduce your risk of heart problems. It is
usually easy to do. A low-fat plant-based diet is a good start. But take one
additional step: avoid sugar, white bread products, and other high-GI foods, as
discussed in Chapter 4. These foods seem to raise triglycerides, while low-GI
foods that are rich in fiber seem to lower them. You will probably see a big drop
in your triglycerides.
ONE SOLUTION TO MANY PROBLEMS
If you have been following along, you have probably come to this happy
conclusion on your own: You do not need one diet for diabetes, another for
cholesterol control, and a third one for weight loss. A diet that skips animal
products, keeps vegetable oils low, and favors high-fiber, low-GI foods tackles
all these problems at the same time.
Just as a drop in cholesterol is good for your heart, a drop in A1C is, too.
People who keep their glucose under good control have fewer heart problems as
the years go by.
The same diet changes also help control your blood pressure, partly because
they can cause you to lose weight, and as your weight falls, so does your blood
pressure. But the effect of vegetarian diets on blood pressure goes beyond their
effect on weight. Plant-based diets are rich in potassium, which seems to reduce
blood pressure. The absence of animal fat also reduces blood viscosity (that is,
blood is less “thick”—less like grease and more like water) so it flows more
easily through the blood vessels.
10
For many people, the effect of diet changes rivals or exceeds that of
medications. If, for whatever reason, your cholesterol, blood pressure, or blood
sugar does not come under good control despite your best efforts, your doctor
will rightly talk with you about medications to take up where diet leaves off.
*
If you are wondering where the term saturated fat came from, it’s actually very logical. If you could look
at a fat molecule under a powerful microscope, it would look like a long chain of carbon atoms, with
perhaps 18 or 20 atoms joined in a line. Attached to the carbon chain are hydrogen atoms. If the chain is
completely covered (i.e., saturated) with hydrogen atoms, the fat becomes a waxy solid and is called a
saturated fat. If, however, hydrogen atoms are absent at several spots on the fat chain, the fat is called
polyunsaturated. Polyunsaturated oils are liquids. And if just one spot on the carbon chain has no hydrogen
atoms attached, the fat is called monounsaturated. Olive and canola oils are rich in this sort of fat. They are
unusual in that they are liquid at room temperature but solid in the refrigerator. Saturated fat is the kind that
pushes your cholesterol upward.
*
The word triglyceride is derived from the fact that when your body transports fat molecules from one
place to another, it generally attaches three fat molecules to a glycerine molecule (hence, tri-glyceride)
before sending them into the watery environment of the bloodstream.
CHAPTER 13
Healthy Nerves, Eyes, and Kidneys
Selwyn was 58 years old when he heard we were looking for volunteers for a
research study. Originally from Trinidad, he had been diagnosed with diabetes
almost 20 years earlier. The disease had taken a toll on his eyes, and he was
being treated for glaucoma.
He also had terrible nerve pain. In the 18 months before the study began, the
pain in his feet had gotten worse and worse. “It was excruciating,” he said. “It
hurt from the calves down, especially on the left side. And it worsened as the
day wore on. By the time I got home from work, I just had to put my feet up. At
night, the bottoms of my feet hurt terribly, with burning and tingling.”
He had had several medical tests to search for a treatable cause, but his
doctors were left with only diabetes to blame for his misery. Despite the fact that
he used insulin twice a day, his diabetes was not under good control.
He began doing stretching exercises, which seemed to ease the pain
somewhat. When our study began, he started a low-fat, vegan diet. It suited his
tastes and had a remarkable effect on his diabetes. At the beginning of the study,
his A1c was 9.1 percent, but his blood sugar began to fall soon after he made the
switch to our eating plan. Within a month, he began to have episodes of low
blood sugar, so his insulin doses were reduced. Despite the fact that he was
taking less medication, his A1C at the 3-month point was down to 7.7. That was
a big improvement, although he was not yet where he needed to be.
However, he kept improving. And about 6 months into the study, something
remarkable happened. “I noticed a drastic change. I had been in total pain, but
the symptoms started going away,” he said. As time went on, things got better
and better. The pain became barely perceptible, and eventually—to his
amazement—it disappeared altogether. “I’m totally normal,” he said. “I have no
pain at all anymore.”
If a medication could deliver the result he achieved, it would be a very
popular one indeed. “The difference has been like night and day for me,” he said.
A healthful diet does much more than keep your blood sugar down; it helps
protect your whole body. If diabetes rages out of control, it can not only damage
your heart, it can also attack your nerves, your eyes, and your kidneys. The diet
you are now beginning will help you avoid these problems. In this chapter, we
will look at how to keep all your body parts in good working order.
HEALTHY NERVES
People with diabetes are at risk of nerve damage, which can take two forms.
Peripheral neuropathy, sometimes called sensorimotor neuropathy, is
damage to the nerves that allow you to feel things or to move your muscles. It
leads to tingling, pain, numbness, or weakness in your feet or hands. It pays to
take these signs seriously because although it can get better, it can also get a lot
worse if you are not careful.
Reduced sensation in your feet can leave you vulnerable to injuries that you
cannot feel. It is easy to overlook a small cut or scrape when you do not feel it.
Injuries can also be slow to heal, which can set you up for a festering infection.
Diabetes is a common cause of amputation, something that should never happen
with good care.
Autonomic neuropathy is abnormalities in the nerves that control your
internal functions. It can lead to digestive problems, such as nausea, vomiting,
constipation, or diarrhea. It can also cause problems with bladder control or
sexual function. Other symptoms include dizziness, faintness, increased or
decreased sweating, visual difficulties (e.g., problems adjusting to light and dark
conditions), and lack of awareness of the warning signs of low blood sugar.
SEE YOUR DOCTOR
Sometimes nerve symptoms have nothing to do with diabetes. If you have
unexplained numbness, pain, tingling, or other nerve symptoms, it is important
to see your doctor to check for conditions that can be treated. For example, if
you are low in vitamin B
12
, you can have nerve pain that is indistinguishable
from the nerve symptoms of diabetes and can end up being permanent. Your
doctor will check your vitamin B
12
blood level and will help you get back on
track, if that is the issue. Nerves are also affected by thyroid conditions,
medications, infections, compression, and other factors. So it’s important to have
a good evaluation.
If the diagnosis is diabetic neuropathy, the key to preventing and treating it is
to get your diabetes—particularly your blood glucose level—under control,
starting with diet and exercise. If neuropathy has affected you, you will want to
reread Chapter 4 and follow the diet guidelines to the letter, aiming for the best
possible glucose control under the guidance of your doctor. There are
medications that can help slightly, but for most people, diet and exercise are far
more powerful.
At California’s Weimar Institute of Health and Education, Milton Crane,
MD, asked 21 diabetes patients with peripheral neuropathy to do two things:
begin a low-fat, vegan diet and take a daily 30-minute walk. The effects were
rapid and very strong: Within 2 weeks, leg pains stopped completely in 17 of the
participants, and the remaining 4 had partial relief.
1
My own research team carried this research a step further. We invited people
with neuropathy to see what a diet change alone could do for them—without
exercise. Not that exercise is bad. Just the opposite, it’s very healthful, but we
wanted to isolate the effect of diet for scientific reasons, to see how powerful
foods could be. Using the diet steps that are now familiar to you (avoiding
animal products, minimizing the use of oils, and favoring low-Glycemic-Index
foods), we found that, for many patients pain improved or simply went away,
and objective tests of nerve function improved, too.
2
Supplements for Treating Neuropathy
Researchers have tested the effects of the following supplements. The verdicts
are not yet in on them as treatments for nerve damage, so I’m listing them here
not as a recommendation but simply to make you aware of them.
Alpha-lipoic acid appears to improve neuropathy symptoms.
3
In research
studies, a dose of 600 milligrams taken once daily was effective.
Gamma-linolenic acid is an omega-6 fatty acid commonly sold in health
food stores. At doses of 480 milligrams per day, it appears to reduce
neuropathy symptoms.
4
Carnitine, in doses of 1,000 milligrams daily, appears to improve nerve
condition and reduce pain in patients with diabetic neuropathy.
5
If You Have Nerve Damage
If the nerves of your feet have been damaged, it is important that you get regular
checkups and protect your feet. If you have lost some feeling, check your feet
daily for any sign of injury or infection, such as redness or swelling, and have it
treated right away. Avoid walking barefoot. If you have lost some feeling in your
feet, you may not know if you step on something that breaks the skin. Be sure
your shoes fit properly to avoid blisters, and break in new shoes slowly. Keep
your nails in good shape, and do not trim them shorter than the ends of your toes.
If your vision is poor or you have difficulty safely trimming your nails, have a
podiatrist examine your feet and trim your nails.
Needless to say, you will want to focus on more than just caring for your
feet. Fight back against neuropathy with a healthy diet—vegan, low-fat, and
low-GI.
HEALTHY EYES
Your eyes are delicate cameras that capture the world around you, transmitting
its details to your brain to perceive and remember. In the same way that a camera
is fragile, several parts of the eye are susceptible to damage. This is true for
anyone, but especially for people with diabetes. Protecting your eyes means
keeping your blood glucose, blood pressure, and cholesterol under control.
Three parts of the eye are particularly vulnerable. First, pressure can build up
in the front part of the eye—called the anterior chamber—and eventually
damage the retina and optic nerve. This is glaucoma. Second, a cataract can
compromise the lens’s clarity. Third, blood vessels in the retina can become
damaged. Let’s look at what we can do to prevent this three-pronged assault.
Glaucoma
There are several different types of glaucoma. Typically, increasing pressure
within the eye pinches the tiny blood vessels in the retina, damaging it and the
optic nerve. High blood pressure and high glucose levels both increase your risk
of developing glaucoma. Your best defense is to get both under control, using the
information in this chapter and the rest of this book. If glaucoma is caught early,
treatment (with prescription eye drops) is highly effective.
Glaucoma can begin with no symptoms at all, so it is important to have eye
examinations by an ophthalmologist at least once a year.
Cataracts
If the lens of the eye loses its clarity, becoming more like waxed paper than like
a clear pane of glass, a doctor diagnoses a cataract. You may experience blurred
or double vision, difficulty with distance vision, a halo effect around lights, or
excessive glare in bright sunlight or while driving at night.
While cataract surgery has advanced dramatically in recent years, the ideal
situation is to keep your original equipment in good working order. Luckily,
there are several things you can do to help prevent cataracts.
First, it is important to avoid tobacco and to protect your eyes from harsh
sunlight.
Second, it pays to follow the same diet steps that apply to controlling
diabetes in general, as described in Chapter 4. That means avoiding animal
products, keeping oils to a minimum, and favoring low-GI foods. There is
evidence that these steps reduce your risk. Specifically, people who avoid fatty
foods tend to have less cataract risk.
6
The same appears to be true for people who avoid dairy products. Generally
speaking, people who steer clear of dairy products appear to have significantly
less risk of developing cataracts.
7
The culprit here appears to be lactose, or milk
sugar, rather than milk fat.
During the digestive process, lactose releases a simple sugar called galactose,
which can enter the lens. Infants who lack the enzymes necessary to break down
galactose develop cataracts within the first year of life. The relationship between
dairy products and cataracts is still being studied, but this is one more good
reason to avoid them.
Certain foods help protect the eyes. Particularly valuable are green leafy
vegetables such as broccoli, spinach, kale, collards, and mustard greens. They
are rich sources of certain antioxidants, called lutein and zeaxanthin, which
protect both the lens and the retina.
8
Foods rich in vitamins c and E may help,
too.
9
You will find plenty of vitamin c in oranges, bell peppers, cantaloupe,
strawberries, and kiwifruit. It also shows up in places you may not expect:
cruciferous vegetables—broccoli, Brussels sprouts, cauliflower, and kale—as
well as tomatoes and sweet potatoes. Healthy sources of vitamin E include
cooked spinach, soy milk, mangoes, and wheat germ. Most nuts and seeds are
particularly rich in vitamin E, but be careful, as they are fatty and loaded with
calories. A small handful has about 5 milligrams of vitamin E.
Finally, people who avoid alcohol have about 10 percent less cataract risk
than other people. Even very modest consumption, about two drinks per week, is
linked to increased risk.
10
Retinopathy
The retina, located at the back of your eye, is like camera film. Millions of tiny
nerves in the retina pick up images and send them to the brain. Also like film,
your retinas are fragile. They can be damaged by high blood sugar, blood
pressure, or cholesterol, leading to a condition called retinopathy, meaning
damage to the retina. The condition occurs in two main forms.
Nonproliferative retinopathy occurs when capillaries balloon out and leak
substances into the retina, leading to the formation of fatty deposits. The
condition is usually mild and needs no treatment, but it is essential that an
ophthalmologist check your eyes regularly to be sure that it does not become
more serious.
Proliferative retinopathy occurs when blood vessels are so damaged that
they begin to close off. When that happens, new, abnormal vessels start to form
in the retina. The new vessels are fragile and prone to bleeding, leading to
scarring and sometimes even to retinal detachment. Ophthalmologists use laser
treatments to treat the abnormal vessels.
Most people with diabetes eventually develop at least a mild degree of
retinopathy. The good news is that there is a lot you can do to prevent serious
problems. Good blood glucose control protects the eyes, and by now you know
how to go about attaining that. Keeping blood pressure and cholesterol down
helps, too. The diet steps above will go a long way toward helping you reach that
goal. If diet alone is insufficient, your doctor will add medications as needed.
Retinopathy begins without symptoms, so it is essential to have your eyes
checked regularly and to choose your foods as if your vision depended on it. It
does.
HEALTHY KIDNEYS
Your kidneys are made up of millions of tiny filtration units. They purify your
blood, sending waste products out into the urine and holding on to proteins and
other normal blood components. But just as the retina’s tiny blood vessels can be
damaged, so can the tiny vessels in your kidneys. High blood pressure, high
blood glucose, and high cholesterol assault them, leading to a condition doctors
call nephropathy.
left uncontrolled, kidney damage can progress to the point where your
options boil down to dialysis or kidney transplant. Needless to say, you do not
want anything like that to happen. Here are the diet steps you need to take.
First, follow the basic diet guidelines for diabetes as described in Chapter 4.
The need is not just for avoiding fat and cholesterol and keeping your blood
glucose and cholesterol down, although those are very important. Animal protein
is part of the problem, too, so you want to avoid it. Since animal protein taxes
the kidneys, getting your protein from plant sources helps protect them.
11
This is an important point, so stick with me while I explain: Many people
imagine that egg white, chicken breast, or haddock are healthful foods because
they are high in protein—but that very fact is what makes them undesirable. The
less animal protein you consume, the lower your risk of kidney problems. You
are much safer getting your protein from plant sources—beans, vegetables, and
grains, for example.
A low-fat, vegan diet is not only free of animal protein, cholesterol, and
animal fat, it also helps bring down high blood pressure,
12
which is also
important for protecting your kidneys.
It goes without saying that you should avoid tobacco. Among its many ill
effects, smoking damages blood vessels.
If your blood pressure, glucose, or cholesterol remains high despite your best
efforts, your doctor will prescribe medications to bring it under control. Some
doctors prescribe medications even if your tests are in the normal range, as a
means of protecting kidney tissues. This is done on an individualized basis.
In a recent study by our research team, we tracked the kidney health of our
participants. They dutifully collected their urine twice over two 24-hour periods
so we could measure their albumin losses (your doctor will probably use less
arduous tests). They did this before beginning their assigned new diets and again
after following them for 22 weeks.
During this time, a group following a “conventional” diet that involved
limited calories and carbohydrates had a 21 percent average drop in albumin
losses. That’s a change in the right direction. However, a group following a low-
fat vegan group had the advantage of consuming no animal protein, animal fat,
or cholesterol, and its average albumin losses were reduced 56 percent, that is,
they fell to less than half of their beginning values.
GETTING HEALTHY AND STAYING THAT WAY
If you have been gaining weight, needing more and more medications, or
developing complications, my goal is to help you change course. We now know
that it is possible to lose weight effectively and permanently, reduce or eliminate
medications, reverse heart disease, and even improve the symptoms of
neuropathy. If you thought you had to surrender to advancing symptoms, it’s
time to think again. You are now in the drivers seat.
CHAPTER 14
Information for Clinicians
Although this book is intended as a tool for people with diabetes, there are a few
key points I would like to mention to physicians and other health care providers.
As you will see, this program is both very effective and highly engaging. While
health care providers are used to seeing their patients becoming frustrated with
typical “diabetes diets” and requiring ever-higher medication dosages, both
physicians and patients find this approach fresh and rewarding.
Health care providers play key roles for individuals on this program, just as
they do with any diabetes treatment program. They educate and encourage their
patients, guide them along the way, and monitor their progress.
In the research studies we have conducted, we have found that many patients
treated with insulin or insulin secretogogues have hypoglycemic episodes as they
improve their diets. As your patients embark on this new diet, you will need to
prepare them for that possibility and be ready to reduce their medications as
needed. It is also important that they understand that the hypoglycemia was
caused by the medications, not by any defect in their physiology. More on this
below.
THE ROLE OF THE HEALTH CARE PROVIDER
There are many ways physicians and other health care providers can help
patients as they begin major dietary changes. First, of course, is encouragement.
Many patients have seen their parents or grandparents end up with frightening
diabetes complications, such as eye problems, loss of kidney function, or
amputations, and many have already begun to experience neuropathy or other
problems by the time they decide to take the disease seriously. They need to
know that they can avoid these problems—as indeed they can—if they follow
your advice, including maintaining a good diet.
It is helpful for them to know that this is not the same diabetes diet they may
have already tried and that they will need to learn a few new tricks. They will
discover new products, new restaurants, and perhaps new menu items at their old
favorite restaurants. The most helpful physicians learn about these diet choices,
too. If you have not yet tried a low-fat, vegan diet, I would strongly encourage
you to do so. Apart from its health benefits, the experience will also prepare you
to answer patients’ questions and offer encouragement.
One way to help patients get started is to ask them to take a week to try out
healthful vegan foods. The idea is not to give up anything. Rather, they are just
trying out some healthful breakfasts, lunches, dinners, and snacks. In a few days,
they will have found many good ideas (more on this in Chapter 5).
Then identify a limited period—say, 3 weeks—in which to give the diet a
good try. For now, there is no need to commit to it forever, but during this short
period, they would do well to follow it 100 percent so they can experience its
full effect. Once they see how it works, they will want to continue.
Avoid the temptation to water down the diet. Clinicians who tell patients to
follow a diet “most of the time” or to “just do the best you can” tacitly encourage
them to deviate from it. We never do that when patients have alcohol or tobacco
problems, because we know that it is easier to stick to a consistent program than
to try to negotiate with these problem substances. The same is true of food; it is
better to encourage patients to give it 100 percent, never setting a foot wrong.
Occasionally, some patients will slip back into their old diet habits. When
that happens, they will almost instantly notice that they no longer manage their
weight as well, and their blood glucose levels will start to climb again. They will
also arrive at your office with a heavy burden of guilt. Many will speak of foods
as “sinful,” “decadent,” etc. I suggest that you remain positive, avoid moralizing,
and return the focus to biology, which is where it belongs. Patients who have
returned fat to their diets may well be packing their cells with more
intramyocellular lipid, which is likely to harm their insulin sensitivity.
Encourage them to dust themselves off and get back on the wagon.
Some patients need to be encouraged to eat carbohydrate-rich foods. Because
of the carbohydrate counting they have already learned, they may have come to
see all carbohydrates as unhealthful. This feeling was aided and abetted by the
never-ending low-carbohydrate diet craze. It is important to remind patients that
countries whose populations have traditionally consumed high-carbohydrate
diets—such as Asian countries, where rice and noodles are dietary staples and
meat and dairy consumption is much less prevalent than in Western countries—
have historically had very low diabetes rates.
You can also help patients ensure nutritional adequacy by asking them to
take a daily B
12
supplement. This is good advice for all patients.
HYPOGLYCEMIA
Patients who are taking insulin or insulin secretogogues are subject to
hypoglycemia. When they improve their diets and begin to lose weight,
hypoglycemic episodes are common. In my experience, most patients on insulin
and about half of all patients on a sulfonylurea who begin a low-fat, vegan diet
have hypoglycemic episodes, usually within the first several weeks.
Patients will be delighted to know that they have improved so much that
their medications are now too strong, but they will also be concerned about what
hypoglycemia means. It is important for them to understand that it was caused
by their medication and that it does not indicate that there is anything wrong
with them. It is also essential for them to know, right from the outset, what to do
and whom to call when these episodes happen. Of course, the initial steps—
checking their blood glucose and taking glucose tablets or food—are things they
can do on their own. But it is important to provide specific instructions and to
ask patients to carry your telephone number (or that of an office backup) with
them and use it as necessary—even on weekends—so you can adjust their
medications. You will find my instructions for patients on dealing with
hypoglycemia in Glucose Testing.
ADDITIONAL RESOURCES
Registered dietitians, as you know, are indispensable allies in your work with
diabetes patients. Ideally, you will want to work with a dietitian who is a
certified diabetes educator and a member of the Academy of Nutrition and
Dietetics’ Vegetarian Nutrition Dietetic practice Group, which includes a large
number of RDs skilled in the use of vegetarian diets.
The Physicians Committee for Responsible Medicine (PCRM) provides free,
noncommercial nutrition information, including continuing medical education on
its Web site, PCRM.org, as well as guidance on how to begin low-fat, vegan
diets. It provides hundreds of recipes, shopping lists, and other user-friendly
information. Please use it and encourage your patients to do so as well. They will
especially like our 21-Day Vegan Kickstart, which offers 3 weeks of menus,
recipes, and cooking videos in several languages, all for free.
If you would like to join in our work to promote healthful diets and tackle
other issues in medicine and research, I hope you will consider joining PCRM.
Members receive our quarterly magazine, Good Medicine, and can sign up to
receive pCRM’s Breaking Medical News, a free, noncommercial service that
alerts you by e-mail when new studies are about to break.
Menus and Recipes
The following menus and recipes were developed and tested by Bryanna Clark
Grogan, a veteran chef, recipe developer, and food writer. Originally from
California, Bryanna now lives in British Columbia. Her many cookbooks cover
an enormous range of foods and cooking styles, from quick and easy recipes to
many kinds of ethnic cuisine.
Bryanna’s recipes are full-bodied, savory dishes with a special “something.”
You will notice that their flavors go beyond the tastes and aromas of the
individual ingredients. The blends of simple foods and well-chosen spices make
each recipe special.
This recipe collection is intended for a wide range of tastes and
temperaments and includes both simple and more adventurous offerings. When
we have included an unusual ingredient, you can find more information in
Appendix 2. Thanks to Gabrielle Turner-McGrievy, PhD, RD, and Jennifer
Reilly, RD, who contributed additional recipes.
HOW TO STEAM-FRY
Some recipes call for steam-frying, a technique for sautéing or stir-frying
without fat. Here is how to do it.
Place a heavy nonstick skillet or stir-fry pan over medium heat and add the
ingredients to be cooked (e.g., chopped onions or other vegetables). Then add 1
to 2 tablespoons of liquid (water, low-sodium vegetable broth, or wine)—just
enough to keep the food from sticking. Do not crowd the pan, or the vegetables
will stew.
Increase the heat to high and cook until the liquid starts to evaporate, stirring
with a wooden spatula or spoon until the vegetables are done to your liking.
You can brown onions perfectly by this method. As soon as the natural
sugars in the onions start to brown on the bottom and edges of the pan, add a
little more liquid and mix the browned portions with the remaining onions.
Continue until the onions are soft and brown, being careful not to scorch them.
To steam-fry in a microwave, use a glass dish, such as a round 10-inch pyrex
baking dish or pie plate. Add the ingredients, including the 1 to 2 tablespoons of
liquid, and cover with a glass lid or microwaveable plate. Microwave on high for
5 minutes or until the vegetables are soft, then add to the recipe. As almost
everyone with a microwave knows, you can cook vegetables in it, but you
cannot brown them or any other food. If you like a brown, crispy texture, stick
with the stovetop method.
7 Days of Healthful Meals
DAY 1
Breakfast
Oatmeal cooked with apples
Soy milk
Lunch
Black-Eyed Pea and Sweet Potato Soup
Toasted rye or sprouted-grain bread
Spinach salad with mandarin orange segments and Creamy Poppy Seed
Dressing
Snack
Fruit Smoothie
Dinner
Lebanese-Style Lentils and Pasta
Steamed broccoli
Orange-Applesauce Date Cake
DAY 2
Breakfast
2 High-Protein Oat Waffles
Sliced berries
Soy yogurt
Lunch
Spinach Hummus and vegetables of choice wrapped in a sprouted-wheat
tortilla
Orange Quinoa and Bulgur Tabbouleh
Snack
Baked corn chips, salsa, and Vegetarian “Refried” Beans
Dinner
Indonesian-Style Stir-Fried Pasta
Thai-Style Coleslaw
Fresh fruit
DAY 3
Breakfast
Tofu Scramblers
Rye toast
Fruit salad
Lunch
Panini sandwich made with sprouted-grain bread, Tofu Mayonnaise, low-
fat vegetarian deli slices, and arugula
Creamy Mushroom Bisque
Snack
Apple slices dipped in Lemon Crème
Dinner
Lemon and Artichoke Tagine
Orange Couscous Pilaf
Baby mixed greens salad with Creamy Black Pepper Dressing
Berry Mousse
DAY 4
Breakfast
Breakfast Barley with Fruit
Soy milk
Lunch
Red Lentil and Sweet Potato Soup
Italian Stuffed Griddle Dumplings
Snack
Raw vegetables
Whole grain rye-crisp crackers
Spinach Dip
Dinner
Eggplant Parmesan
Green salad with Balsamic Vinaigrette
Bulgur Wheat and Quinoa Pilaf
Fresh fruit
DAY 5
Breakfast
Frozen fat-free hash browns baked in a nonstick waffle iron
Low-fat vegetarian sausage
Sliced oranges
Lunch
Black Bean Soft Tacos
Cherry Tomato and Brown Rice Salad with Artichoke Hearts
Snack
Orange-Applesauce Date Cake
Nondairy milk
Dinner
Balkan-Style Slow-Cooker Stew
Crusty rye bread
Brussels Sprouts with Lemon and Vegetarian Bacon
Fresh fruit
DAY 6
Breakfast
Muesli Cereal
Soy milk
Fresh fruit
Lunch
Sloppy Joes for Two on sprouted-wheat hamburger buns
Green salad
Snack
Whole grain crackers
Cypriot Yellow Split Pea and Dill Spread
Dinner
White Bean and Sweet Potato Stew
Sprouted grain buns
Sautéed Portobello Mushroom Salad
Cranberry–Orange–Pear Granola Crisp
DAY 7
Breakfast
Wheatberry Pancakes with apple-cider maple syrup
Fresh fruit
Lunch
Barley and Winter Squash Chowder
Oatmeal Drop Scones
Red Cabbage Slaw with Cranberries and Apples
Snack
Pineapple Sherbet Pops
Dinner
Vegetarian Mixed-Bean Chili Express
Tender Barley Cornbread
BLT Salad
Chocolate-Dipped Strawberries
Breakfasts
Breakfast Barley with Fruit
For delicious taste, lots of soluble fiber, and a wonderfully low glycemic index,
try rolled barley (also called barley flakes) for your breakfast porridge. It takes a
bit longer to cook than oatmeal unless you soak it the night before. Serve with
your favorite nondairy milk and a touch of brown sugar or the sweetener of your
choice.
⅓ cup rolled barley (barley flakes)
⅛ teaspoon salt
¾ cup water
1 tablespoon wheat bran
½ medium apple with peel, cored and chopped, or other chopped fruit
1½ teaspoons ground flaxseed
The night before: Combine the barley, salt, and water in a microwaveable bowl,
cover, and refrigerate overnight. (Use a 1-quart or larger bowl—barley can really
boil up!)
In the morning: Add the bran and apple or other fruit to the soaked barley. Cover
the bowl with a microwaveable plate and microwave on high for 2 minutes.
Finish cooking on medium for 4 minutes. Stir in the flaxseed.
To cook on the stovetop: Bring the soaked barley, bran, and apple or other fruit to
a boil in a small nonstick saucepan over high heat, stirring. Reduce the heat to
low, partially cover, and simmer for about 15 minutes, stirring occasionally. The
mixture should have the consistency of cooked oatmeal. If it’s too watery,
continue cooking over low heat to desired consistency.
MAKES 1 SERVING
Per serving: 197 calories, 6 g protein, 8 g carbohydrates, 8 g sugar, 2 g total fat,
10% calories from fat, 0 mg cholesterol, 42 g fiber, 252 mg sodium
Tofu Scramblers
It takes about the same amount of time to make Tofu scramblers as it does to
make scrambled eggs when you use the handy homemade mix. Shake or stir the
mix before measuring. Scramblers can be used in breakfast burritos or soft tacos
made with sprouted wheat or corn tortillas, topped with salsa, or used in vegan
huevos rancheros.
Scrambler Mix
1 cup nutritional yeast flakes
5 tablespoons + 1 teaspoon onion powder
4 teaspoons curry powder
4 teaspoons salt
4 teaspoons ground turmeric
4 teaspoons ground cumin
Scramblers
1½ teaspoons Tofu scrambler Mix
4 ounces reduced-fat extra-firm silken tofu, crumbled
2 tablespoons reduced-fat soy milk (optional)
For the mix: Blend the yeast flakes, onion powder, curry powder, salt, turmeric,
and cumin in a dry blender or mini-processor. Store in a covered jar.
For the scramblers: Combine the scrambler mix and tofu well in a medium
bowl. Add the soy milk, if desired. Cook the mixture in a heavy nonstick skillet
until it reaches the desired consistency, stirring constantly with a plastic spatula.
To microwave, combine the ingredients in a microwaveable dish, cover, and
cook on high (for 4 ounces, about 2 minutes; for 8 ounces, about 3½ minutes; for
12 ounces, about 5 minutes; and for 16 ounces, about 7½ minutes).
MAKES 1 SERVING
Per serving: 54 calories, 9 g protein, 3 g carbohydrates, 1 g sugar, 1 g total fat,
15% calories from fat, 0 mg cholesterol, 1 g fiber, 252 mg sodium
Variations
If you like, add chopped vegetarian bacon or ham; vegetarian bacon bits; or
steam-fried chopped onions, scallions, mushrooms, bell peppers, or tomatoes. If
cooking in the microwave, place the vegetables in the bottom of the dish, put the
tofu (mixed with the scrambler mix) on top, and cook as usual, then stir together
before serving.
Muesli Cereal
Bircher muesli was invented in Switzerland as a nutritious raw but digestible
breakfast cereal. You can buy expensive commercial versions, but the original is
low in fat, easy to make, and quick, as long as you remember to start the night
before. Serve muesli with reduced-fat nondairy milk or soy yogurt; brown sugar,
maple syrup or agave syrup to taste; and fresh fruit (such as berries), if desired.
1½ cups rolled oats or other rolled whole grain cereal
1½ cups water
2 tablespoons wheat bran
2 tablespoons currants, raisins, or other dried fruit
¼ teaspoon salt
2 medium apples with peel, grated
3 tablespoons lemon juice
The night before: Combine the oats and water in a bowl and refrigerate
overnight.
Just before serving: Add the bran, currants or raisins, salt, apples, and lemon
juice to the soaked oats.
Note: To make 1 serving, use 6 tablespoons oats; 6 tablespoons water; 1
teaspoon bran; 1 teaspoon dried fruit; a pinch of salt; ½ small apple, shredded;
and 2¼ teaspoons lemon juice.
MAKES 4 SERVINGS
Per serving: 173 calories, 6 g protein, 36 g carbohydrates, 11 g sugar, 2 g total
fat, 10% calories from fat, 0 mg cholesterol, 6 g fiber, 122 mg sodium
Oatmeal Drop Scones
Traditional Scottish skon recipes contained no fat at all. They were eaten
immediately, warm and fresh, as these should be. Enjoy them with low-sugar
jam.
1 cup old-fashioned oats
1¼ cups whole wheat pastry flour (not regular whole wheat flour)
1 teaspoon sugar
½ teaspoon baking soda
½ teaspoon salt
1¼ cups reduced-fat soy milk
1 tablespoon lemon juice or vinegar
Sugar or caraway seed
Preheat the oven to 400°F. Grind the oats to a fine meal in a dry blender. Pour
into a medium bowl and add the flour, sugar, baking soda, and salt. Mix well.
Mix the soy milk and lemon juice or vinegar in a small bowl. Pour into the dry
mixture and stir briefly with a fork. Drop by large spoonfuls onto 2 nonstick
baking sheets (or baking sheets lined with parchment), making 12 mounds.
Smooth the tops a bit with wet fingertips. Bake for about 15 minutes. Split with
a fork while still hot.
For a bannock shape: Divide the dough in half. With wet hands, pat the dough
pieces into 8" circles in two 9" nonstick cake pans (or cake pans lined with
parchment cut to fit). Score each circle into 6 wedges and bake for 15 to 20
minutes.
Sprinkle with the sugar or caraway seed.
MAKES 12 SERVINGS
Per serving: 77 calories, 3 g protein, 15 g carbohydrates, 1 g sugar, 1 g total fat,
9% calories from fat, 0 mg cholesterol, 2 g fiber, 144 mg sodium
Variations
Currant Scones: Add ¼ to ½ cup dried currants. You can also add ¾ cup grated
apple.
Herb Scones: Add ½ cup loosely packed chopped fresh herbs of your choice.
Herb Bannock: This resembles a focaccia, is quick to make, and is a great snack.
Add ½ cup fresh herbs to the oatmeal scone dough. Divide the dough in half and
follow the instructions for making the bannock shape. Make indentations all over
the dough with your fingertips. Spray the tops lightly with water from a pump
sprayer and sprinkle with coarse salt or soy Parmesan, or top with steam-fried
or grilled chopped mushrooms, garlic, bell peppers, and/or onions. Serve with
balsamic vinegar for dipping.
Tender Barley Cornbread
You can whip up this high-fiber, low-fat cornbread fast, and it bakes in 15
minutes. Use stone-ground cornmeal if you can.
¾ cup yellow cornmeal
½ cup barley flour
⅓ cup whole wheat flour (regular or pastry flour)
2 tablespoons sugar
2 teaspoons baking powder
½ teaspoon salt
¼ teaspoon baking soda
1 cup reduced-fat soy milk
¼ cup unsweetened applesauce
Preheat the oven to 425°F. Whisk together the cornmeal, barley and whole wheat
flours, sugar, baking powder, salt, and baking soda in a medium bowl. Add the
soy milk and applesauce and stir just until mixed. Scrape into an 8" × 8"
nonstick baking pan and smooth the top. Bake for 15 minutes. Cut the hot
cornbread into 6 equal pieces.
MAKES 6 SERVINGS
Per serving: 150 calories, 4 g protein, 32 g carbohydrates, 5 g sugar, 1 g total
fat, 6% calories from fat, 0 mg cholesterol, 3 g fiber, 237 mg sodium
High-Protein Oat Waffles
If you didn’t make these crisp, ultra-nutritious waffles yourself, you’d never
guess beans were among the ingredients. Soaking the beans takes just minutes
before you retire for the night, and in the morning, you can make the batter
quickly in the blender. (Note: To cook waffles without added fat, you will need a
good-quality nonstick waffle iron.)
These waffles take a little longer to bake than ordinary waffles (about 8
minutes), so you may want to make them ahead of time. They can be reheated
quickly in a toaster. Topped with chili or creamed vegetables, they make a great
lunch or supper. For gluten-free waffles, substitute brown rice flakes or quinoa
flakes for the oats.
½ cup dried cannellini, white kidney, or great northern beans
2¼ cups water
1¾ cups old-fashioned oats
2 tablespoons sugar or 1 tablespoon agave nectar
¾ tablespoon whole flaxseed
1 tablespoon baking powder
1½ teaspoons vanilla extract, or ¾ teaspoon vanilla extract and ¾ teaspoon
orange, almond, or coconut extract
1 teaspoon salt
The night before: Place the beans in a large bowl and cover generously with
water. Refrigerate overnight or for up to a week.
In the morning: Drain the beans, discarding the soaking water. Place in a blender
with cups fresh water and the oats, nectar, flaxseed, baking powder, vanilla,
and salt. Blend until smooth, light, and foamy. Set aside and preheat a nonstick
waffle iron.
Pour a generous ⅓ cup of batter onto the hot waffle iron for each 4" waffle, close
the iron, and cook for a minimum of 8 minutes. If the iron is hard to open, let the
waffle cook for another minute or two.
Repeat with the remaining batter, blending briefly before pouring each waffle. If
the batter thickens while standing, add enough water to return it to its original
consistency.
The waffles should be golden brown and crisp. Serve immediately or cool
completely on a rack and freeze in an airtight container. Serve with your favorite
toppings.
MAKES TEN 4" WAFFLES (5 SERVINGS)
Per serving: 196 calories, 10 g protein, 35 g carbohydrates, 2 g sugar, 3 g total
fat, 11% calories from fat, 0 mg cholesterol, 6 g fiber, 386 mg sodium
Wheatberry Pancakes
Who would guess that with the help of your blender, you could make deliciously
light pancakes from freshly ground wheat in minutes? Try these! Leftover batter
works great for waffles, too.
1 cups wheat berries (whole wheat kernels)
1 tablespoon whole flaxseed
2 cups water
⅓ cup chickpea flour (besan) or low-fat soy flour
1 tablespoon sugar
2 teaspoons lemon juice
2 teaspoons baking powder
½ teaspoon baking soda
½ teaspoon salt
Place the wheat berries, flaxseed, and water in a blender and process at high
speed for about 2 minutes. Add the flour and process for 2 to 3 minutes or until
very smooth. Add the sugar, lemon juice, baking powder, baking soda, and salt
and process until well mixed.
Heat a heavy nonstick griddle or skillet (a nonstick electric griddle cooks very
evenly) over high heat until drops of water dance on the surface and then quickly
disappear. Reduce the heat to medium-high. Working in batches if necessary,
pour dollops of batter quickly onto the griddle, leaving space to expand. When
bubbles appear on the surface, gently flip the pancakes. Don’t overcook; they
should be a bit puffy when you take them off the griddle, so they are light and
cakey.
MAKES TWELVE 4" PANCAKES (3 SERVINGS)
Per serving: 261 calories, 11 g protein, 53 g carbohydrates, 6 g sugar, 3 g total
fat, 9% calories from fat, 0 mg cholesterol, 9 g fiber, 534 mg sodium
Fruit Smoothie
This quick and easy recipe is great way to start your day—or give you a healthy
boost anytime.
½ cup unsweetened apple or orange juice
½ cup reduced-fat soy milk
½ cup frozen blueberries or other berries
½ cup frozen peaches
1 tablespoon soy protein powder
Combine the juice, soy milk, berries, peaches, and protein powder in a blender
or food processor. Blend until very smooth.
MAKES 1 SERVING
Per serving: 148 calories, 4 g protein, 32 g carbohydrates, 13 g sugar, 2 g total
fat, 9% calories from fat, 0 mg cholesterol, 3 g fiber, 65 mg sodium
Dips, Spreads, and Dressings
Low-Fat Guacamole
This “mock-amole” is creamy and tasty. It is delicious with baked corn tortilla
chips.
5 ounces fresh green beans or frozen small whole green beans
5 ounces frozen baby lima beans
½ cup reduced-fat firm or extra-firm silken tofu
3 tablespoons lemon juice
2 cloves garlic, crushed
¾ teaspoon salt
½ teaspoon ground cumin
¼ cup chunky no-sugar-added tomato salsa
Cook the green beans and lima beans in enough water to cover for about 5
minutes or just until tender but not mushy. Drain well, transfer to a food
processor, and blend until smooth.
Add the tofu, lemon juice, garlic, salt, and cumin and blend until smooth. Add
the salsa and pulse briefly to mix. Scoop into a covered bowl and refrigerate.
MAKES 2 CUPS
Per ¼ cup: 37 calories, 2 g protein, 7 g carbohydrates, 1 g sugar, 0.5 g total fat,
5% calories from fat, 0 mg cholesterol, 2 g fiber, 226 mg sodium
Vegetarian “Refried” Beans
This fat-free version of refried beans has a light texture and can be made with a
variety of beans. It also makes a great warm bean dip or a delicious cold spread
for sandwiches, wraps, or crackers.
4½ cups cooked or 3 cans (15 ounces each) black, small red, kidney, or pinto
beans, rinsed and drained
1 small onion, finely chopped
2 tablespoons red wine vinegar
1 teaspoon salt
1 teaspoon ground cumin
1 teaspoon dried oregano
1 teaspoon dried garlic granules
1 teaspoon chili powder
Hot-pepper sauce to taste (optional)
A few dashes of liquid smoke (optional)
Place the beans, onion, vinegar, salt, cumin, oregano, garlic granules, chili
powder, hot-pepper sauce, if desired, and liquid smoke, if desired, in a food
processor. Blend for several minutes or until very smooth. Transfer to a serving
bowl, cover, and refrigerate.
For a hot dip, microwave on high for about 3 minutes or heat in a skillet, stirring
constantly.
MAKES 4 CUPS
Per ¼ cup: 68 calories, 4 g protein, 12 g carbohydrates, 0.5 g sugar, 0.5 g total
fat, 4% calories from fat, 0 mg cholesterol, 4 g fiber, 120 mg sodium
Spinach Hummus
Most versions of this popular Middle Eastern chickpea dip are chock-full of
olive oil and sesame tahini. This recipe contains a little tahini and plenty of
spinach or other greens for good nutrition and lots of color. Serve with raw
veggies and wedges of sprouted-wheat pita bread or with fat-free dark rye-crisp
crackers. Heating the chickpeas before processing makes a creamier hummus.
1 package (10 ounces) frozen spinach, thawed
2 cups well-cooked chickpeas or 1 can (19 ounces) chickpeas, heated and
drained
⅓ cup lemon juice
1 tablespoon sesame tahini
4–6 cloves garlic
1½ teaspoons salt
1 teaspoon ground cumin
¼ teaspoon cayenne pepper
Squeeze as much liquid from the spinach as you can and chop with a sharp knife.
Set aside.
Place the chickpeas, lemon juice, tahini, garlic, salt, cumin, and cayenne in a
food processor. Blend until as smooth as desired, adding a bit of water if
necessary (it will thicken somewhat in the refrigerator). Add the spinach and
blend briefly.
Transfer to a serving bowl, cover with plastic wrap, and refrigerate until ready to
serve.
MAKES ABOUT 3½ CUPS
Per ¼ cup: 107 calories, 7 g protein, 19 g carbohydrates, 0.5 g sugar, 2 g total
fat, 13% calories from fat, 0 mg cholesterol, 6 g fiber, 336 mg sodium
Variations
Try this recipe with cooked or thawed frozen kale, Swiss chard, or collard greens
instead of spinach.
For a more traditional hummus, omit the greens and decrease the salt to 1
teaspoon, the cumin to ½ teaspoon, and the cayenne to a pinch.
For delicious red pepper hummus, make the traditional hummus variation and
add ½ cup drained and rinsed roasted red peppers from a jar when you process
the chickpeas.
Cypriot Yellow Split Pea and Dill Spread
This easy spread is delicious with dark rye-crisp crackers or sprouted-wheat pita
wedges. The garlic mellows considerably when cooked.
1 cup dried yellow split peas
7 cloves garlic
1 small onion, chopped
1 teaspoon salt
3 cups water
3 tablespoons fresh lemon juice
2 teaspoons dried dill weed or 2 tablespoons chopped fresh dill
Freshly ground black pepper to taste
Paprika (optional)
1 sprig fresh dill (optional)
Combine the split peas, 6 of the garlic cloves, onion, salt, and water in a medium
saucepan. Bring to a boil, skimming off any foam. Reduce the heat, cover, and
simmer for 30 minutes.
Transfer to a food processor or blender and process, or use a hand-held blender
in the pan. (Remove the “pusher” from the top of the food processor so hot air
can escape. Cover the hole loosely with a folded clean cloth while processing.)
crush the remaining garlic clove and add to the mixture along with the lemon
juice and dill. Process until very smooth. Season with the pepper.
Pour into a decorative serving bowl, cover, and let cool. Garnish with the paprika
and dill sprig, if desired.
This spread is best served at room temperature. If you store it in the refrigerator,
simply bring it to room temperature before serving.
MAKES 2½ CUPS
Per ¼ cup: 74 calories, 5 g protein, 14 g carbohydrates, 2 g sugar, 0.5 g total
fat, 2% calories from fat, 0 mg cholesterol, 5 g fiber, 193 mg sodium
Red Wine Vinaigrette
This is a good basic dressing for many types of salads. Unlike plain juice or
water, the oil substitute will help the dressing stick to the greens. I like to make 2
cups at a time and refrigerate the extra.
Fat-Free oil Substitute
1 cup cold water
1 tablespoon low-sodium vegetarian broth powder
2 teaspoons cornstarch
Dressing
1¼ cups Fat-Free Oil Substitute
¼ cup red wine vinegar
1 tablespoon balsamic vinegar
1 clove garlic, crushed
1 teaspoon salt
1 tablespoon Dijon mustard (optional)
1 tablespoon brown sugar (optional)
For the oil substitute: Place the water in a small saucepan and whisk in the broth
powder and cornstarch. Cook over medium-high heat, stirring constantly, until
thickened and clear.
For the dressing: Whisk, shake, or blend the oil substitute, red wine and
balsamic vinegars, garlic, salt, mustard, if desired, and sugar, if desired, until
well mixed. Transfer to a jar and refrigerate.
MAKES 1½ CUPS
Per 2 tablespoons: 6 calories, 0.5 g protein, 2 g carbohydrates, 0 g sugar, 0 g
total fat, 0% calories from fat, 0 mg cholesterol, 0.5 g fiber, 160 mg sodium
Variation
Balsamic Vinaigrette: Omit the red wine vinegar and use 5 tablespoons balsamic
vinegar. Use the optional mustard and brown sugar.
Per 2 tablespoons: 11 calories, 0.5 g protein, 3 g carbohydrates, 1 g sugar, 0.5 g
total fat, 3% calories from fat, 0 mg cholesterol, 0.5 g fiber, 176 mg sodium
Spinach Dip
Serve this blender dip with raw vegetables and/or fat-free dark rye-crisp
crackers.
20 ounces reduced-fat extra-firm silken tofu
¼ cup lemon juice
1 envelope Lipton Recipe Secrets Vegetable Soup Mix
½ teaspoon salt
1 package (10 ounces) frozen chopped spinach, thawed and squeezed dry
2 scallions, minced
1 can (8 ounces) water chestnuts, drained and chopped (optional)
1 tablespoon vegetarian bacon bits (optional)
Place the tofu, lemon juice, soup mix, and salt in a food processor and blend
until smooth. Add the spinach, scallions, water chestnuts, if desired, and bacon
bits, if desired, and pulse until mixed. Transfer to a serving bowl, cover, and
refrigerate until ready to serve.
MAKES 4 CUPS (12 SERVINGS)
Per serving: 16 calories, 1 g protein, 3 g carbohydrates, 1 g sugar, 0.5 g total
fat, 10% calories from fat, 0 mg cholesterol, 1 g fiber, 226 mg sodium
Creamy Poppy Seed Dressing
This quick and easy dressing is very low in fat. With just the right amount of
sweetness, it’s great on fruit salads and spinach salads.
8 ounces reduced-fat firm or extra-firm silken tofu, crumbled
6 ounces (½ can) frozen apple juice concentrate, thawed
6 tablespoons reduced-fat soy milk
3 tablespoons cider vinegar
1 tablespoon poppy seeds
1½ tablespoons chopped onion
1½ tablespoons dijon mustard
1 scant teaspoon salt
Place all the ingredients in a blender and process until smooth. Transfer to a jar
and refrigerate. Shake before serving.
MAKES 2 CUPS
Per ¼ cup: 45 calories, 3 g protein, 7 g carbohydrates, 1 g sugar, 1 g total fat,
18% calories from fat, 0 mg cholesterol, 0.5 g fiber, 268 mg sodium
Creamy Black Pepper Dressing
This is sure to be a favorite, especially if you are a fan of spinach salads. The
blender is the key to the creamy texture.
1½ tablespoons low-sodium vegetarian broth powder
1 package (12.3 ounces) reduced-fat firm silken tofu
1 large clove garlic, finely chopped
3 tablespoons fresh lemon juice
1 tablespoon rice vinegar
1 tablespoon nutritional yeast flakes
1½ teaspoons whole black peppercorns
1 teaspoon miso
1 teaspoon sugar
¾ teaspoon salt
⅔ cup water
Place all the ingredients in a blender and process until very smooth. Transfer to a
jar and refrigerate. Shake well before serving.
MAKES 2 CUPS
Per 2 tablespoons: 15 calories, 2 g protein, 2 g carbohydrates, 0.5 g sugar, 0.5 g
total fat, 11% calories from fat, 0 mg cholesterol, 0.5 g fiber, 123 mg sodium
Soups
Dutch Green Pea Soup
A very satisfying meal on a cold day! Serve this soup hot along with dark
pumpernickel bread.
1 cup green split peas
8 cups low-sodium vegetarian broth
1 tablespoon vegetarian bacon bits
2 medium new or red potatoes, peeled and chopped
2 medium leeks, chopped, including any tender green parts
½ cup chopped celery, including leaves
½ teaspoon dried savory
½ teaspoon liquid smoke
1 package (10–12 ounces) low-fat vegetarian hot dogs or sausages, sliced
diagonally into chunks
Salt to taste
Freshly ground black pepper to taste
Bring the split peas, broth, and bacon bits to a boil in a large saucepan,
skimming off any foam. Reduce the heat, cover, and simmer for about 3 hours.
Add the potatoes, leeks, celery, savory, liquid smoke, and hot dogs or sausages.
Simmer for 30 minutes or until the potatoes are tender. Season with the salt and
pepper.
MAKES 8 SERVINGS
Per serving: 184 calories, 15 g protein, 27 g carbohydrates, 3 g sugar, 3 g total
fat, 11% calories from fat, 0 mg cholesterol, 7 g fiber, 36 mg sodium
Barley and Winter Squash Chowder
This is a lovely soup for a cold evening.
4 cups low-sodium vegetarian broth
1 pound winter squash, peeled, seeded, and cut into ¾" cubes
½ large onion, chopped
6 ounces low-fat chicken substitute strips, such as Butler Soy Curls,
reconstituted
¾ cup pearled barley
8 ounces red potatoes, chopped
¼ cup chopped celery leaves and tops
1½ teaspoons vegetarian bacon bits
1 bay leaf
½ teaspoon dried thyme
½ teaspoon dried savory
1½ cups reduced-fat soy milk
Salt to taste
Freshly ground black pepper to taste
Chopped fresh parsley (optional)
Place the broth, squash, onion, chicken substitute strips, barley, potatoes, celery,
bacon bits, bay leaf, thyme, and savory in a soup pot and bring to a boil. Reduce
the heat to low, cover, and simmer for 30 minutes. Remove the bay leaf, stir in
the soy milk, and season with the salt and pepper. Sprinkle each serving with
chopped parsley, if desired.
MAKES 6 SERVINGS
Per serving: 204 calories, 11 g protein, 40 g carbohydrates, 4 g sugar, 1 g total
fat, 4% calories from fat, 0 mg cholesterol, 8 g fiber, 229 mg sodium
Creamy Mushroom Bisque
A food processor turns this dairy-free soup into a rich, creamy treat with a
delightful mushroom flavor.
1 small onion, finely chopped
5 cups mushroom broth
1 bay leaf
½ teaspoon dried thyme
⅔ cup old-fashioned oats
12 ounces mushrooms, sliced
2 teaspoons low-sodium soy sauce
2 tablespoons dry sherry (optional)
Salt to taste
Freshly ground black pepper to taste
Vegan Parmesan cheese (optional)
Steam-fry the onion in a heavy nonstick skillet over medium heat until soft but
not browned, adding very small amounts of water as needed to prevent sticking
and burning. (Or place in a microwaveable dish, cover, and microwave on high
for 3 minutes.)
Place the broth, bay leaf, thyme, and oats in a medium saucepan. Add the onion
and bring to a boil, then reduce the heat to low, cover, and simmer for 20
minutes or until the oats are soft.
Meanwhile, steam-fry the mushrooms in a large, heavy nonstick skillet over high
heat, adding a sprinkle of salt and very small amounts of water as needed to
prevent sticking and burning. Cook until the mushrooms release and reabsorb
their liquid. Remove from the heat and set aside.
When the oats are soft, remove the bay leaf and puree the soup until creamy with
a hand-held blender or in batches in a blender or food processor. (Remove the
middle part of the blender or food processors lid so hot air can escape. Cover
the hole loosely with a folded clean cloth while blending.)
Return the soup to the pan and add the mushrooms, soy sauce, sherry (if
desired), salt, pepper, and vegan Parmesan (if desired). Serve hot.
MAKES 4 SERVINGS
Per serving: 80 calories, 5 g protein, 14 g carbohydrates, 3 g sugar, 1 g total fat,
12% calories from fat, 0 mg cholesterol, 3 g fiber, 93 mg sodium
Black-Eyed Pea and Sweet Potato Soup
This delectable soup contains Southern ingredients—black-eyed peas, vegetarian
bacon and sausage, sweet potatoes, and greens.
1 large onion, chopped
3 cloves garlic, minced
6 cups low-sodium vegetarian broth
¼ cup tomato paste
3 cups cooked or 2 cans (15 ounces each) black-eyed peas, rinsed and drained
2 tablespoons vegetarian bacon bits or a few dashes of liquid smoke
2 teaspoons dried oregano
1 bay leaf
½ teaspoon salt
½ teaspoon crushed red pepper
4 ounces kale, collards, or other dark greens, cleaned, trimmed, and thinly
sliced
1 pound sweet potatoes, peeled and chopped
2 vegetarian italian sausages, such as Lightlife smart Links italian or Yves
Veggie Spicy Italian Sausage, cut into ¼" slices
Steam-fry the onion and garlic in a large, heavy nonstick skillet over medium
heat until soft, adding very small amounts of water as needed to prevent sticking
and burning. (Or place in a microwaveable dish, cover, and microwave on high
for 5 minutes.)
Place the broth, tomato paste, black-eyed peas, bacon bits or liquid smoke,
oregano, bay leaf, salt, red pepper, greens, sweet potatoes, and sausage in a large
saucepan. Add the onion and garlic and simmer for 30 minutes or until the sweet
potatoes are tender. Remove the bay leaf and serve immediately.
MAKES 6 SERVINGS
Per serving: 257 calories, 16 g protein, 44 g carbohydrates, 8 g sugar, 3 g total
fat, 10% calories from fat, 0 mg cholesterol, 10 g fiber, 263 mg sodium
Red Lentil and Sweet Potato Soup
This hearty soup makes a great light lunch or a starter for a several-course meal.
Blending gives it a delightfully smooth texture.
2 small onions, chopped
½ teaspoon ground cumin
½ teaspoon ground ginger
4 cups low-sodium vegetarian broth
2 cups cubed peeled sweet potatoes
⅔ cup red or pink lentils, rinsed
1 teaspoon lemon juice
¼ teaspoon salt
White pepper to taste
Paprika
Steam-fry the onions in a large, heavy nonstick skillet over medium heat until
soft, adding very small amounts of water as needed to prevent sticking and
burning. (Or place in a microwaveable dish, cover, and microwave on high for 5
minutes.) stir in the cumin and ginger and blend well.
Place the broth, sweet potatoes, and lentils in a medium soup pot. Add the
onions and simmer, uncovered, for about 30 minutes or until the lentils are
tender. Add the lemon juice, salt, and white pepper. Process using a hand-held
blender in the pan or in batches in a blender or food processor, until creamy.
(Remove the middle part of the blender or food processor lid so hot air can
escape. Cover the hole loosely with a folded clean cloth while blending.) Serve
hot and with paprika sprinkled on top of each bowl.
MAKES 4 SERVINGS
Per serving: 185 calories, 10 g protein, 36 g carbohydrates, 4 g sugar, 1 g total
fat, 3% calories from fat, 0 mg cholesterol, 6 g fiber, 158 mg sodium
Sandwiches and Salads
Black Bean Soft Tacos
In Mexico, tacos are usually made with fresh, hot tortillas (not deep-fried ones).
This machine-blended filling brings you all the traditional taste and heartiness of
the real thing.
Tofu Sour Cream
1 package (12.3 ounces) reduced-fat extra-firm silken tofu, crumbled
3 tablespoons lemon juice
½ teaspoon sugar
¼ teaspoon salt
Tacos
8 corn tortillas (6")
1½ cups Vegetarian “Refried” Beans made with black beans
2 cups (1 recipe) Low-Fat Guacamole
1 cup no-sugar-added tomato salsa
4 cups finely shredded green cabbage or lettuce
1 cup Tofu sour cream
For the tofu sour cream: Place the tofu, lemon juice, sugar, and salt in a food
processor or blender and process until very smooth. Refrigerate in a covered
container for up to 1 week.
For the tacos: Heat the tortillas (see Note). Spread about 3 tablespoons of beans
down the middle of each tortilla. Top with guacamole, salsa, cabbage or lettuce,
and tofu sour cream. Eat out of hand with lots of napkins!
Note: If the tortillas are frozen, heat them between two microwaveable plates on
high for about 1 minute, then turn over the plates and heat for 1 minute longer.
You can soften thawed or fresh tortillas in a hot, dry pan; grill them quickly just
until soft; or wrap them in a clean kitchen towel moistened with hot water, then
wrap them in foil and place them in the oven until all are heated. Or, wrap the
tortillas in a clean kitchen towel moistened with hot water, wrap them in foil, and
bake them in a 350°F oven for about 12 minutes.
If you have a noninsulated microwaveable steamer, place a little hot water under
the steamer tray. Wrap the thawed tortillas in a clean kitchen towel and place
them in the steamer tray. Cover and microwave for 2 to 3 minutes for 6 tortillas
or 4 minutes for 12 tortillas. If you leave the wrapped tortillas in the steamer,
they will stay hot during the meal.
MAKES 8 SERVINGS
Per serving: 174 calories, 10 g protein, 33 g carbohydrates, 3 g sugar, 1 g total
fat, 7% calories from fat, 0 mg cholesterol, 7 g fiber, 557 mg sodium
Asparagus and Veggie Ham Panini
This Italian panini will become a lunchtime favorite.
2 slices rye or sprouted-grain bread
2 tablespoons Tofu Mayonnaise
6 thin asparagus spears, steamed or roasted
6 fresh basil leaves
2 slices low-fat vegetarian bacon or ham, such as Yves Veggie Canadian
Bacon
Spread each bread slice on 1 side with 1 tablespoon tofu mayonnaise and
assemble the sandwich with the rest of the ingredients the way you like it, being
careful not to overfill.
The easiest way to make panini is with an electric nonstick panini press or closed
indoor grill. Set the timer for 5 minutes, then check the bread. If it is not as
golden and crisp as you like, cook for a few minutes longer. Cut the sandwich
into triangles and serve hot.
If you do not have a panini press or grill, cook the sandwich in a heavy nonstick
skillet or on a griddle over medium heat, placing a flat heavy lid on the sandwich
as you brown each side.
Per serving (using rye bread): 308 calories, 31 g protein, 32 g carbohydrates,
0.2 g sugar, 4 g total fat, 11% calories from fat, 0 mg cholesterol, 6 g fiber, 825
mg sodium
Italian Stuffed Griddle Dumplings (Consum)
This traditional “griddle dumpling” from Romagna is actually a stuffed Italian
flatbread, similar to a calzone but stuffed with greens. This easy version uses
whole wheat pitas.
6 whole wheat pitas
½ pound Swiss chard, beet greens, spinach, or savoy cabbage, or a mixture
½ pound bitter greens, such as arugula, radicchio, rapini, Chinese broccoli,
mustard or turnip greens, or curly endive
1½ teaspoons chopped garlic
¼ cup low-sodium vegetarian broth
¼ teaspoon salt, and extra to taste
Freshly ground black pepper to taste
Cut the pitas in half and open to form a pocket. Wash, trim, and thinly slice the
greens.
Place the garlic, broth, greens, and salt in a large, deep nonstick skillet. Bring to
a boil, then cover, reduce the heat to medium, and cook until tender. If any liquid
remains, uncover and cook over high heat, stirring constantly, until it evaporates.
Season with the salt and pepper and set aside to cool.
Drain the greens and stuff inside the pita halves. Heat the filled pitas on a hot,
dry griddle or cast-iron pan over high heat, turning frequently, until hot and
flecked with brown spots. Serve hot.
MAKES 6 SERVINGS
Per serving: 188 calories, 8 g protein, 38 g carbohydrates, 2 g sugar, 2 g total
fat, 8% calories from fat, 0 mg cholesterol, 6 g fiber, 510 mg sodium
Mediterranean Veggie Panini
Italian sandwich making has become an art form in the northern city of Milan
and has spread all over Europe and North America. Sandwich bars in italy range
from humble places to the height of sophistication, and some offer as many as 30
varieties.
2 slices rye or sprouted-grain bread, such as Ezekiel Bread
2 tablespoons fat-free italian vinaigrette dressing
2 jarred roasted red peppers, rinsed and patted dry
1 cup tender kale leaves or other greens
2 small firm, ripe tomatoes, sliced (fresh Roma tomatoes are best because they
are not overly juicy)
½ cup sliced marinated artichoke hearts, rinsed, drained, and patted dry
Moisten each bread slice on 1 side with 1 tablespoon dressing and assemble the
sandwich with the rest of the ingredients the way you like it, being careful not to
overfill.
The easiest way to make panini is with an electric nonstick panini press or closed
indoor grill. Set the timer for 5 minutes, then check the bread. If it is not as
golden and crisp as you like, cook for a few minutes longer. Cut the sandwich
into triangles and serve hot.
If you do not have a panini press or grill, cook the sandwich in a heavy nonstick
skillet or on a griddle over medium heat, placing a flat heavy lid on the sandwich
as you brown each side.
MAKES 1 SERVING
Per serving (using rye bread): 311 calories, 13 g protein, 49 g carbohydrates,
4.9 g sugar, 3 g total fat, 8% calories from fat, 0 mg cholesterol, 13.3 g fiber, 849
mg sodium
Sloppy Joes for Two
Here’s a tasty and healthful version of an old favorite.
½ small onion, finely chopped
½ small green bell pepper, cored, seeded, and chopped
½ small red bell pepper, cored, seeded, and chopped
6 medium mushrooms, chopped
¾ cup low-fat vegetarian hamburger crumbles
½ cup fat-free barbecue sauce, such as Bull’s-Eye Original
1 tablespoon tomato paste dissolved in ½ cup hot water
2 sprouted-wheat hamburger buns, such as Alvarado Street Bakery buns, split
and toasted
Steam-fry the onions, peppers, and mushrooms in a heavy nonstick skillet over
high heat until softened, adding water by the tablespoon as needed to prevent
sticking and burning.
Add the hamburger crumbles, barbecue sauce, and tomato paste mixture. Cook,
stirring, until the sauce is the desired consistency. Spoon over the split buns or
fill them like a sandwich.
MAKES 2 SERVINGS
Per serving: 218 calories, 14 g protein, 40 g carbohydrates, 11 g sugar, 2 g total
fat, 7% calories from fat, 0 mg cholesterol, 6 g fiber, 508 mg sodium
Orange Quinoa and Bulgur Tabbouleh
This is a delicious and unusual version of the well-known Middle eastern salad.
½ cup medium-grain bulgur wheat
1½ cups water
½ cup quinoa
¾ cup Fat-Free Oil Substitute
¼ cup lemon juice
1 teaspoon salt
1 teaspoon ground coriander
2 pinches ground cinnamon
Freshly ground black pepper to taste
2 cups chopped fresh parsley
1 cup cooked or canned black-eyed peas, rinsed and drained
⅔ cup chopped, seeded green bell pepper
½ cup chopped fresh mint or lemon balm
½ cup chopped scallion
Grated peel of 2 oranges
4 jarred roasted red peppers, rinsed and chopped
Orange wedges (optional)
Mint, parsley, or lemon balm sprigs (optional)
Soak the bulgur in ½ cup boiling water in a large bowl, covered, for 30 minutes.
Meanwhile, bring the quinoa and 1 cup water to a boil in a small saucepan.
Reduce the heat to low, cover, and cook for 15 minutes. Remove from the heat
and let stand until the bulgur is ready.
Whisk or blend together the oil substitute, lemon juice, salt, coriander,
cinnamon, and black pepper in a small bowl. Set aside.
Combine the quinoa with the bulgur. Add the parsley, black-eyed peas, bell
pepper, mint or lemon balm, scallion, orange peel, red peppers, and oil dressing
and mix well. Garnish with orange wedges and sprigs of mint, parsley, or lemon
balm, if desired. Refrigerate, but let stand at room temperature for 30 minutes
before serving.
MAKES 8 SERVINGS
Per serving: 136 calories, 5 g protein, 29 g carbohydrates, 2 g sugar, 1 g total
fat, 7% calories from fat, 0 mg cholesterol, 7 g fiber, 303 mg sodium
Cherry Tomato and Brown Rice Salad with Artichoke Hearts
This delicious salad is a complete meal and a great picnic or potluck dish.
Because neither tomatoes nor rice benefit from refrigeration, it should be served
at room temperature.
3 cups cooked brown basmati rice, warm
6 ounces marinated artichoke hearts, rinsed in hot water, drained, and sliced
1 cup chopped scallions
1½ pounds red, yellow, or mixed cherry tomatoes, halved
½ cup chopped fresh basil
½ cup fat-free Italian dressing
3 tablespoons lemon juice
2 cloves garlic, crushed
¼ teaspoon salt
Freshly ground black pepper to taste
1 head crisp lettuce
Place the rice in a large salad bowl and add the artichokes, scallions, tomatoes,
and basil. Mix gently.
Combine the italian dressing, lemon juice, garlic, salt, and pepper in a small
bowl or jar. Whisk or shake until well blended. Pour over the salad and mix
gently. Serve on beds of lettuce on individual plates.
MAKES 6 SERVINGS
Per serving: 153 calories, 4 g protein, 32 g carbohydrates, 3 g sugar, 1 g total
fat, 6% calories from fat, 0 mg cholesterol, 4 g fiber, 376 mg sodium
Thai-Style Coleslaw
This easy coleslaw makes a great winter accompaniment to an Asian meal or
spices up any other meal.
3 cups finely shredded green or savoy cabbage
1 medium carrot, shredded
1 small sweet onion, thinly sliced
2 tablespoons minced fresh mint or 2 teaspoons dried mint
2 tablespoons minced fresh cilantro, basil, or parsley
2 tablespoons low-sodium soy sauce
2 tablespoons lime juice
2 tablespoons water
1 tablespoon sugar
1 tablespoon grated lime peel
1½ teaspoons toasted sesame seeds
Combine the cabbage, carrot, onion, mint, and cilantro, basil, or parsley in a
serving bowl.
Combine the soy sauce, lime juice, water, sugar, and lime peel in a small bowl.
Pour over the salad, mix well, and refrigerate until ready to serve. Sprinkle with
the sesame seeds before serving.
MAKES 4 SERVINGS
Per serving: 61 calories, 2 g protein, 13 g carbohydrates, 8 g sugar, 1 g total fat,
10% calories from fat, 0 mg cholesterol, 3 g fiber, 334 mg sodium
Red Cabbage Slaw with Cranberries and Apples
This is a very easy, attractive, and delicious make-ahead salad for winter holiday
meals. A blender makes the vinaigrette in a jiffy.
Cranberry-orange Vinaigrette
¾ cup Fat-Free Oil Substitute
½ cup orange juice
⅓ cup chopped fresh or frozen cranberries
2 tablespoons red wine vinegar
1½ tablespoons chopped chives or scallion
1 tablespoon balsamic vinegar
1 tablespoon lemon juice
1 tablespoon sugar
1 large clove garlic, crushed
1 teaspoon salt
Freshly ground black pepper to taste
Salad
1½ pounds red cabbage, thinly sliced (about 5 cups)
¾ cup fresh or frozen cranberries
2 crisp sweet apples, sliced
For the vinaigrette: Blend the oil substitute, orange juice, cranberries, wine
vinegar, chives or scallion, balsamic vinegar, lemon juice, sugar, garlic, salt, and
pepper in a blender. If making ahead, transfer to a covered container and
refrigerate.
For the salad: Combine the cabbage, cranberries, and vinaigrette in a medium
salad bowl and toss gently. Cover and refrigerate for at least 2 hours to allow the
flavors to blend. When ready to serve, slice the apples (with peel), add to the
salad, and toss well.
MAKES 8 SERVINGS
Per serving: 70 calories, 1 g protein, 18 g carbohydrates, 11 g sugar, 0.5 g total
fat, 2% calories from fat, 0 mg cholesterol, 3 g fiber, 251 mg sodium
Sautéed Portobello Mushroom Salad
This is a very simple and delicious salad for two.
8 cups cleaned mixed baby salad greens
¼ cup Fat-Free Oil Substitute
2 tablespoons balsamic vinegar
1 teaspoon Dijon mustard
¼ teaspoon salt
¼ teaspoon coarsely ground black pepper
2 large portobello mushrooms
Wine or vegetable broth
4 scallions, sliced
Divide the greens between two serving plates. In a small bowl, whisk together
the oil substitute, vinegar, mustard, salt, and pepper. Set aside.
Remove the stems from the mushrooms and scrape away the dark gills with the
edge of a spoon.
Heat a large, heavy nonstick skillet over high heat and add the mushrooms.
Cover and cook until slightly browned on the bottoms and beginning to release a
bit of liquid. Add a very small amount of wine or broth as needed to prevent
sticking. Turn the mushrooms and brown the other side.
Quickly slice the mushrooms and place them evenly over the greens. Drizzle
with the dressing, sprinkle with the scallions, and serve immediately.
MAKES 2 SERVINGS
Per serving: 95 calories, 7 g protein, 19 g carbohydrates, 4 g sugar, 1 g total fat,
6% calories from fat, 0 mg cholesterol, 7 g fiber, 308 mg sodium
BLT Salad
A salad version of the well-loved sandwich that uses a handy mayonnaise
substitute. Cooks, plug in your blenders!
Tofu mayonnaise
1 package (12.3 ounces) reduced-fat extra-firm silken tofu
2 tablespoons cider vinegar or lemon juice
1⅛ teaspoons salt
½ teaspoon dry mustard
⅛ teaspoon white pepper
Salad
6 cups torn romaine lettuce
6 cups cubed sprouted-wheat bread, lightly toasted
4 slices low-fat vegetarian bacon, such as Yves Veggie Canadian Bacon or
Lightlife Fakin’ Bacon
2 cups chopped ripe firm tomatoes
2 scallions, sliced
½ cup cider vinegar
⅓ cup Fat-Free Oil Substitute
¼ cup Tofu Mayonnaise
5 teaspoons sugar
Freshly ground black pepper to taste
For the mayonnaise: Combine the tofu, vinegar or lemon juice, salt, mustard,
and pepper in a food processor or blender (or place the ingredients in a medium
bowl and use a hand-held blender) and process until very smooth. It will keep in
a covered container in the refrigerator for about 2 weeks.
For the salad: Combine the lettuce, bread cubes, bacon, tomatoes, and scallions
in a large bowl.
Whisk together the vinegar, oil substitute, tofu mayonnaise, sugar, and pepper in
a medium bowl until well blended. Toss with the salad. Divide the salad evenly
among 4 salad bowls or plates and serve immediately.
MAKES 4 SERVINGS
Per serving: 259 calories, 13 g protein, 42 g carbohydrates, 11 g sugar, 2 g total
fat, 8% calories from fat, 0 mg cholesterol, 10 g fiber, 639 mg sodium
Main Courses
Balkan-Style Slow-Cooker Stew
Balkan cooking is similar to Greek cuisine. Serve with toasted sprouted-wheat
bread or buns for dipping.
3 large onions, sliced
3 cloves garlic, minced
4 large red, yellow, green, or mixed bell peppers, sliced into thin strips
12 ounces low-fat chicken substitute strips, such as Yves Veggie Chicken
Tenders or Lightlife Smart Menu Chik’n Strips
1 can (14 ounces) low-sodium diced tomatoes
1 small dried red chile pepper, seeded
½ teaspoon ground cloves
½ teaspoon ground cinnamon
¼ teaspoon ground allspice
2 cups low-sodium vegetarian broth
Salt to taste
Freshly ground black pepper to taste
Heat a large, heavy nonstick skillet over high heat. Add the onions, garlic, and
bell peppers. Steam-fry until the onion softens, adding very small amounts of
water as needed to prevent sticking and burning.
Place the chicken substitute strips in a slow cooker and spoon the cooked
vegetables on top. Stir in the tomatoes (with juice), chile pepper, cloves,
cinnamon, allspice, and broth. Cook on high for 3 hours. Season with the salt
and black pepper.
MAKES 4 SERVINGS
Per serving: 185 calories, 19 g protein, 30 g carbohydrates, 12 g sugar, 1 g total
fat, 2% calories from fat, 0 mg cholesterol, 9 g fiber, 550 mg sodium
White Bean and Sweet Potato Stew
All you need is whole grain bread to go with this Italian-inspired stew.
1 large onion, chopped
4 cloves garlic, chopped
3 cups cooked or 2 cans (15 ounces each) cannellini, white kidney, or great
Northern beans, rinsed and drained
1 can (28 ounces) low-sodium diced tomatoes
1 pound sweet potatoes, peeled and chopped
12 ounces kale, stripped from stalks, washed, thinly sliced, and briefly
steamed
8 ounces cremini mushrooms, sliced
½ cup low-sodium vegetarian broth
½ cup dry red wine (can be nonalcoholic) or ¼ cup dry sherry
1 tablespoon vegetarian bacon bits
1 teaspoon salt
1 teaspoon dried rosemary
1 teaspoon dried thyme
1 teaspoon dried basil
1 bay leaf
¼ teaspoon crushed red pepper
Salt to taste
Freshly ground black pepper to taste
Steam-fry the onion and garlic in a large, heavy nonstick skillet over medium
heat until soft, adding very small amounts of water, wine, or broth as needed to
prevent sticking and burning. (Or place in a microwaveable dish, cover, and
microwave on high power for 5 minutes.)
Combine the onions and garlic with the beans, tomatoes (with juice), sweet
potatoes, kale, mushrooms, broth, wine, bacon bits, salt, rosemary, thyme, basil,
bay leaf, and red pepper in a slow cooker. Cook on low for 6 to 7 hours or on
high for 3 to 4 hours. Remove the bay leaf and season with the salt and pepper.
MAKES 6 SERVINGS
Per serving: 257 calories, 14 g protein, 50 g carbohydrates, 9 g sugar, 2 g total
fat, 4% calories from fat, 0 mg cholesterol, 12 g fiber, 418 mg sodium
Lebanese-Style Lentils and Pasta
This delicious Lebanese dish makes a full meal.
5 cups low-sodium vegetarian broth
1 cup uncooked brown lentils, rinsed
2 medium onions, chopped
2 cloves garlic, chopped
1 teaspoon ground cumin
4 cups chopped chard, kale, or other greens or 1 package (10 ounces) frozen
chopped spinach, thawed and squeezed dry
4 ounces spaghetti or spaghettini (preferably whole wheat), broken into 4"-
long pieces
¼ cup chopped fresh parsley or cilantro (optional) pinch of cayenne pepper
2 tablespoons lemon juice
Salt to taste
Freshly ground black pepper to taste
Bring the broth and lentils to a boil in a medium saucepan. Reduce the heat to
low, cover, and cook for about 25 minutes or until the lentils are tender but still
hold their shape.
Steam-fry the onions, garlic, and cumin in a large, heavy nonstick saucepan, stir-
fry pan, or deep skillet until soft, adding very small amounts of water as needed
to prevent sticking and burning. (Or place in a microwaveable dish, cover, and
microwave on high for 7 minutes.)
Pour the lentils and broth into the pan with the onions. Add the greens, pasta,
parsley or cilantro, if desired, and cayenne. Bring to a boil, then reduce the heat
to medium. Cook, uncovered, for about 10 minutes or until the pasta is tender
and most of the broth has been absorbed, leaving a sauce. Add the lemon juice
and mix well. Season with the salt and black pepper. Serve hot.
MAKES 4 SERVINGS
Per serving: 318 calories, 20 g protein, 61 g carbohydrates, 7 g sugar, 1 g total
fat, 3% calories from fat, 0 mg cholesterol, 17 g fiber, 204 mg sodium
Lemon and Artichoke Tagine (Moroccan Stew)
Serve this delicious stew with Bulgur Wheat and Quinoa Pilaf.
2 tablespoons whole wheat flour
12 ounces low-fat chicken substitute strips, such as Yves Veggie Chicken
Tenders, Lightlife Smart Menu Chik’n Strips, or Morningstar Farms Meal
Starters Chik’n Strips
1 large onion, sliced
6 cloves garlic, chopped
2 cups sliced mushrooms
1 large green or red bell pepper, cored, seeded, and cut into chunks
2 cups low-sodium vegetarian broth
1 tablespoon ground coriander
1 tablespoon dried parsley
½ teaspoon black pepper
¼ teaspoon ground turmeric
¼ teaspoon ground ginger
¼ teaspoon paprika
¼ teaspoon crushed red pepper
1 lemon, with peel, sliced and seeded
1 jar (7 ounces) marinated artichoke heart quarters, rinsed under hot water and
drained
Salt to taste
Place the flour in a shallow dish and roll the chicken substitute strips to coat.
Place the strips in a large, heavy, deep nonstick skillet or stir-fry pan over
medium-high heat and cook until browned. Remove from the pan and set aside.
Add the onion and garlic to the skillet and steam-fry until soft, adding very small
amounts of water as needed to prevent sticking and burning. (Or place in a
microwaveable dish, cover, and microwave on high for 7 minutes.)
Add the strips, mushrooms, bell pepper, broth, coriander, parsley, black pepper,
turmeric, ginger, paprika, and red pepper. Place the lemon slices on top of the
stew, cover, reduce the heat, and simmer for 30 minutes.
Remove and discard the lemon slices. Stir in the artichokes and cook just until
heated. Season with the salt and serve immediately.
MAKES 4 SERVINGS
Per serving: 165 calories, 20 g protein, 25 g carbohydrates, 3 g sugar, 1 g total
fat, 3% calories from fat, 0 mg cholesterol, 10 g fiber, 584 mg sodium
Pasta with Lentil Marinara Sauce
Red wine (which can be a nonalcoholic variety) lends a rich flavor to this sauce,
which is ready in the time it takes to cook the pasta.
1 pound pasta of choice
1 jar (26 ounces) fat-free low-sodium tomato-based pasta sauce
1 can (15 ounces) lentils, rinsed and drained
½ cup dry red wine (can be nonalcoholic) or low-sodium vegetarian broth
Salt to taste
Freshly ground black pepper
Cook the pasta according to package directions, then drain.
Meanwhile, combine the pasta sauce, lentils, and wine or broth in a medium
saucepan. Heat gently and season with the salt and pepper. Serve over the pasta.
MAKES 5 SERVINGS
Per serving: 470 calories, 19 g protein, 91 g carbohydrates, 9 g sugar, 2 g total
fat, 3% calories from fat, 0 mg cholesterol, 8 g fiber, 173 mg sodium
Vegetarian Mixed-Bean Chili Express
This chili is an absolutely delicious savory treat. Serve it with brown basmati
rice, sprouted-grain bread or buns, corn or sprouted-wheat tortillas, soft fresh
polenta or cornbread, and a salad. Leftovers freeze well.
6 cloves garlic, minced or crushed
1 tablespoon chili powder (preferably a dark variety, such as ancho)
1 tablespoon dried oregano
1½ teaspoons ground cumin
½ teaspoon crushed red pepper
1 can (28 ounces) low-sodium diced tomatoes
1½ cups cooked or 1 can (15 ounces) pinto beans, rinsed and drained
1½ cups cooked or 1 can (15 ounces) black beans, rinsed and drained
1½ cups cooked or 1 can (15 ounces) small red or red kidney beans, rinsed
and drained
3 cups hot water
1½ cups dry textured vegetable protein
1 cup frozen whole-kernel corn
1 large green bell pepper, cored, seeded, and chopped
¼ cup low-sodium soy sauce
1 tablespoon hot-pepper sauce
1 tablespoon onion powder
1 tablespoon unsweetened cocoa powder
1 teaspoon sugar
2 tablespoons cornmeal or masa harina
Salt to taste
Steam-fry the garlic in a large, heavy nonstick skillet for 2 minutes. Add the chili
powder, oregano, cumin, and red pepper and stir-fry for 1 minute. Add the
tomatoes (with juice), beans, hot water, vegetable protein, corn, bell pepper, soy
sauce, hot-pepper sauce, onion powder, cocoa, and sugar. Bring to a boil, then
reduce the heat, cover, and simmer for 15 to 30 minutes. During the last 5
minutes of cooking, sprinkle the cornmeal or masa harina over the top and stir in
thoroughly. Season with the salt.
MAKES 6 SERVINGS
Per serving: 329 calories, 26 g protein, 57 g carbohydrates, 7 g sugar, 2 g total
fat, 4% calories from fat, 0 mg cholesterol, 16 g fiber, 457 mg sodium
Black-Eyed Peas with Sweet Potatoes and Greens
A wonderful combination of flavors! Serve with brown rice or fat-free
cornbread, with hot sauce on the side.
1 package (10 ounces) frozen kale, chard, or collard greens
4 cups low-sodium vegetarian broth
2 packages (10 ounces each) frozen black-eyed peas, thawed and drained
2 cloves garlic, minced
1 can (18 ounces) vacuum-packed unsweetened sweet potatoes, drained,
rinsed, and chopped, or 2 cups cooked
A few dashes of liquid smoke
Thaw the greens in the microwave or a bowl of boiling water and drain. Chop
and combine with the broth, black-eyed peas, garlic, sweet potatoes, and liquid
smoke in a large saucepan. Bring to a boil, stirring often, then reduce the heat
and simmer for 20 to 30 minutes.
MAKES 4 SERVINGS
Per serving: 412 calories, 32 g protein, 74 g carbohydrates, 1 g sugar, 4 g total
fat, 8% calories from fat, 0 mg cholesterol, 22 g fiber, 127 mg sodium
Indonesian-Style Stir-Fried Pasta (Bamie)
This dish has just the right exotic touch.
1 pound soy vermicelli pasta
1 medium onion, chopped
6 cloves garlic, minced
½–1 teaspoon crushed red pepper
2 cups shredded napa or savoy cabbage
2 stalks celery, sliced thinly on the diagonal
¼ cup water
6 ounces low-fat beef substitute strips, such as Yves Veggie Beef Tenders,
Lightlife Smart Menu Steak-Style Strips, or Morningstar Farms Meal
Starters Steak Strips
½ cup low-sodium vegetarian broth
¼ cup low-sodium soy sauce
¾ tablespoon maple syrup
¾ tablespoon dark molasses
2 teaspoons cornstarch
1 tablespoon cold water
4 scallions, sliced thinly on the diagonal
Cook the pasta in a large pot of boiling water until tender. Drain in a colander.
In a large, heavy nonstick wok or a skillet lightly coated with oil or cooking
spray, steam-fry the onion, garlic, and red pepper for 1 minute, adding very small
amounts of water as needed to prevent sticking and burning.
Add the cabbage, celery, and ¼ cup water. Cover and cook over high heat for
about 3 minutes. Add the beef substitute strips and stir-fry for about 1 minute.
Combine the broth, soy sauce, maple syrup, molasses, cornstarch, and cold water
in a small bowl. Stir into the pan and cook, stirring, over high heat until it
thickens and boils.
Add the drained pasta and toss well with the sauce. Top with the scallions and
serve.
MAKES 6 SERVINGS
Per serving: 338 calories, 10 g protein, 74 g carbohydrates, 19 g sugar, 1 g total
fat, 2% calories from fat, 0 mg cholesterol, 5 g fiber, 505 mg sodium
Quick Spinach Lasagna
Although it takes a little more than an hour to make this dish, most of that is
cooking time; prep takes just a few minutes.
1 package (10 ounces) frozen spinach, thawed
1 pound reduced-fat firm tofu
1 tablespoon chopped or minced garlic
1 teaspoon salt
1 jar (26 ounces) fat-free low-sodium tomato-based pasta sauce
1 pound whole wheat lasagna noodles
10 button mushrooms, sliced, or 1 cup other vegetable of choice
¼ cup vegan parmesan or nutritional yeast flakes
Preheat the oven to 325°F.
Combine the spinach, tofu, garlic, and salt in a medium bowl.
Coat the bottom of a 9" × 13" baking pan with tomato sauce, then add a layer of
lasagna noodles, overlapping them slightly. Spread half of the spinach mixture
over the noodles. Follow with another layer of noodles, then tomato sauce, and a
layer of mushrooms or other veggies. Repeat until the layers reach the top of the
pan. The final layer should be sauce topped with vegan parmesan or yeast flakes.
Cover tightly with foil and bake for 1 hour. Stick a knife through the center of
the lasagna to be sure the noodles are completely cooked. Let stand for 15
minutes, uncovered, before serving.
MAKES 8 SERVINGS
Per serving: 332 calories, 18 g protein, 5 g carbohydrates, 7 g sugar, 5 g total
fat, 9% calories from fat, 0 mg cholesterol, 9 g fiber, 284 mg sodium
Recipe by Jennifer Reilly, RD
Eggplant Parmesan
This interpretation of an old favorite appeals to modern tastes, with “béchamel”
sauce and vegan Parmesan providing a creamy contrast.
Creamy Béchamel Sauce
½ medium onion, cut into chunks
1 cup water
¾ cup cooked or canned white beans, rinsed and drained
6 ounces reduced-fat firm silken tofu
1 tablespoon nutritional yeast flakes
1 teaspoon salt
¼ teaspoon dried garlic granules
Eggplant
3 pounds eggplant, cut into ¼"-thick slices
¾ cup fine dry bread crumbs
3 cups fat-free tomato-based pasta sauce
2 cups Creamy Béchamel Sauce
½ cup vegan parmesan
For the sauce: Simmer the onion with 1 cup water in a medium saucepan,
covered, for about 10 minutes. Place in a blender or food processor with the
remaining ingredients and blend until very smooth. The sauce can be refrigerated
in a covered container for up to 1 week.
For the eggplant: Arrange the eggplant slices in a single layer on a nonstick
baking sheet. Broil 3" to 4" from the heat on both sides until lightly browned and
soft inside (or grill on a nonstick indoor grill).
Preheat the oven to 325°F. Lay half of the eggplant in the bottom of a 10" round
nonstick baking pan (or a baking pan lined with parchment) and top with half of
the bread crumbs. Spread with half of the pasta sauce, béchamel sauce, and
vegan Parmesan. Repeat with the remaining ingredients. Bake for 20 minutes, or
until bubbly and browned on top.
MAKES 6 SERVINGS
Per serving: 262 calories, 11 g protein, 34 g carbohydrates, 7 g sugar, 1 g total
fat, 6% calories from fat, 0 mg cholesterol, 10 g fiber, 697 mg sodium
Easy Veggie Fajitas
This restaurant favorite is easy to make at home.
1 medium onion, cut into strips
¼ cup low-sodium vegetarian broth or water
1 teaspoon ground cumin
3 red, yellow, green, or mixed bell peppers, cored, seeded, and cut into strips
2 cans (15 ounces each) black beans, drained and rinsed
6 whole wheat tortillas (8" to 10")
1 cup no-sugar-added tomato salsa
Steam-fry the onion in a large, heavy nonstick skillet until soft, adding very
small amounts of broth or water as needed to prevent sticking and burning. Add
the cumin and bell peppers and cook over medium heat until the peppers are
tender. Heat the beans on high in the microwave for 1 minute.
Place a tortilla in a large, heavy skillet over medium-low heat. Add ½ cup of the
beans and ½ cup of the onion mixture. Fold the tortilla in half over the filling
and cook for 3 minutes. Repeat with the remaining tortillas and filling. Top with
salsa and serve.
MAKES 6 SERVINGS
Per serving: 257 calories, 13 g protein, 50 g carbohydrates, 8 g sugar, 2 g total
fat, 7% calories from fat, 0 mg cholesterol, 11 g fiber, 408 mg sodium
Recipe by Jennifer Reilly, RD
Sides
Orange Couscous Pilaf
Couscous looks like a grain but is actually a type of semolina pasta that cooks
quickly and makes a delicious side dish.
2 cups low-sodium vegetarian broth
1 cup couscous
1 cup grated carrots
2 large oranges, peeled and cut into small chunks
4 teaspoons grated orange peel
2 tablespoons raisins
¼ teaspoon salt
¼ teaspoon ground cinnamon
Bring the broth and couscous to a boil in a large saucepan over high heat. Add
the carrots, oranges, orange peel, raisins, salt, and cinnamon. Return to a boil,
then turn off the heat, cover, and let stand for 10 minutes or until all liquid is
absorbed. Fluff with a fork.
MAKES 4 SERVINGS
Per serving: 238 calories, 7 g protein, 52 g carbohydrates, 4 g sugar, 1 g total
fat, 2% calories from fat, 0 mg cholesterol, 7 g fiber, 143 mg sodium
Brussels Sprouts with Lemon and Vegetarian Bacon
This is a delicious and quick brussels sprout dish. You can partially cook the
sprouts ahead of time, stop the cooking with ice water, and then assemble and
stir-fry the dish in minutes just before serving.
3 pounds brussels sprouts, trimmed and halved vertically
1 cup chopped vegetarian bacon (about 8 slices), such as Yves Veggie
Canadian Bacon or Lightlife Fakin’ Bacon
4 scallions, chopped
¼ cup low-sodium vegetarian broth salt to taste
Freshly ground black pepper to taste
2 tablespoons lemon juice
Add the brussels sprouts to a saucepan of boiling water and cook for 3 minutes.
Drain immediately and plunge into ice-cold water to stop the cooking process.
When they are cold, drain well.
Heat a large nonstick skillet, wok, or stir-fry pan over high heat. Add the bacon
and scallions and steam-fry until the scallions are soft, adding very small
amounts of water as needed to prevent sticking and burning. Add the sprouts and
broth and stir-fry for about 3 minutes. Season with the salt and pepper and
drizzle with the lemon juice. Toss and serve immediately.
MAKES 8 SERVINGS
Per serving: 71 calories, 12 g protein, 5 g carbohydrates, 1 g sugar, 0.5 g total
fat, 6% calories from fat, 0 mg cholesterol, 2 g fiber, 331 mg sodium
Bulgur Wheat and Quinoa Pilaf
This is a tasty side dish for any meal.
1 cup bulgur wheat
1 cup quinoa
1 large onion, chopped
1 cup chopped celery
4 cups low-sodium vegetarian broth
¼ cup minced fresh parsley
1 teaspoon crushed dried rosemary or dried thyme or oregano
Salt to taste
Place the bulgur and quinoa in a dry heavy skillet (such as cast-iron), stir-fry
pan, or wok over high heat and cook, stirring constantly, until the grain smells
toasty. Remove from the heat immediately and set aside.
Steam-fry the onion and celery in a large nonstick saucepan with a tight lid until
the onion begins to soften. Add the broth, bulgur, quinoa, parsley, and rosemary,
thyme, or oregano. Bring to a boil over high heat, then reduce the heat to low
and cook, covered, for 20 minutes. Let stand for 5 minutes. Fluff with a fork and
season with the salt.
MAKES 8 SERVINGS
Per serving: 174 calories, 6 g protein, 36 g carbohydrates, 1 g sugar, 2 g total
fat, 7% calories from fat, 0 mg cholesterol, 6 g fiber, 46 mg sodium
Broccoli Stir-Fry in Black Bean Sauce
This is a colorful, quick, and fiber-rich accompaniment to any Asian-style meal.
1 teaspoon minced or grated fresh ginger
2 teaspoons crushed garlic
2 tablespoons Chinese black bean sauce
1 bunch broccoli
1 large onion, cut into 6 wedges and layers separated
2 tablespoons water
3 tablespoons dry sherry or nonalcoholic sweet wine, such as Riesling
1½ teaspoons cornstarch dissolved in ½ cup cold water
Mash the ginger and garlic together in a small bowl. Add the black bean sauce
and mix well.
Divide the broccoli florets into bite-size pieces. Peel and chop the stems into ½"
pieces and stir-fry with the florets and onion in a medium skillet over high heat.
Add 2 tablespoons water, cover, and cook for 4 to 5 minutes or just until the
broccoli is crisp-tender (add a little more water if necessary).
Add the ginger mixture, sherry or wine, and cornstarch mixture and stir until the
sauce is thickened. Serve immediately.
MAKES 4 SERVINGS
Per serving: 85 calories, 6 g protein, 15 g carbohydrates, 1 g sugar, 1 g total fat,
4% calories from fat, 0 mg cholesterol, 0.5 g fiber, 416 mg sodium
Roasted Sweet Potatoes with Moroccan Spices
These sweet potatoes are easy to prepare, but your guests don’t have to know
that. The seeds add crunch as well as spice.
1½ pounds orange-fleshed sweet potatoes, peeled, halved lengthwise, and cut
crosswise into ½" slices
¼ cup fat-free Italian dressing
1 tablespoon maple syrup
1½ teaspoons grated lemon peel
1½ teaspoons coriander seeds
1½ teaspoons cumin seeds
1½ teaspoons mustard seeds
Salt to taste
Freshly ground black pepper to taste
Position a rack in the bottom third of the oven and preheat the oven to 375°F.
Toss the sweet potatoes, dressing, maple syrup, lemon peel, and coriander,
cumin, and mustard seeds together in a heavy nonstick rimmed baking sheet or
shallow baking pan, then spread evenly in a shallow layer. Sprinkle with salt and
pepper. Roast until tender and golden brown, stirring occasionally, for 30 to 45
minutes. Serve hot.
MAKES 5 SERVINGS
Per serving: 145 calories, 3 g protein, 33 g carbohydrates, 9 g sugar, 1 g total
fat, 3% calories from fat, 0 mg cholesterol, 5 g fiber, 233 mg sodium
Roasted Green Beans, Fennel, Red Pepper, and Cauliflower with
Dill
This is a delicious, easy, and colorful vegetable presentation.
2 medium fennel bulbs, tops cut off, halved, trimmed, and sliced
1 medium cauliflower, trimmed, broken into florets, and sliced
2 large red bell peppers, cored, seeded, and thickly sliced
6 cups fresh green beans, trimmed, or frozen whole young green beans
½ cup fat-free Italian dressing
2 tablespoons lemon juice
2 teaspoons dried dill weed or 2 tablespoons chopped fresh dill
1 teaspoon dried garlic granules
¼ cup chopped fennel leaves
Salt to taste
Freshly ground black pepper to taste
Preheat the oven to 350°F. Combine the fennel bulbs, cauliflower, bell peppers,
beans, dressing, lemon juice, dill, garlic granules, fennel leaves, salt, and black
pepper in a single layer in a large, shallow nonstick baking pan (use two pans if
necessary to keep the vegetables in 1 shallow layer).
Place the pan or pans on the bottom oven rack. Bake for about 40 minutes,
stirring occasionally with a spatula, until the vegetables are tender and beginning
to brown slightly. Serve hot.
MAKES 8 SERVINGS
Per serving: 85 calories, 4 g protein, 19 g carbohydrates, 6 g sugar, 0.5 g total
fat, 3% calories from fat, 0 mg cholesterol, 7 g fiber, 254 mg sodium
Desserts
Chocolate-Dipped Strawberries
This treat gives you the taste of rich chocolate with the healthful goodness of
fresh fruit. Wax Orchards fat-free, fruit-sweetened organic fudge toppings are
available in most health food stores. They come in six varieties.
¼ cup Wax Orchards fudge topping
12 large fresh whole strawberries, cleaned, with stems
Heat the topping in a small saucepan just until softened. Divide equally into 2
small bowls. Hold the strawberries by the stem ends, dip in the topping, and
enjoy!
MAKES 2 SERVINGS
Per serving: 125 calories, 1 g protein, 29 g carbohydrates, 23 g sugar, 1 g total
fat, 5% calories from fat, 0 mg cholesterol, 4 g fiber, 41 mg sodium
Cranberry–Orange–Pear Granola Crisp
Cranberries, oranges, and pears are made for each other. Serve this crisp with
Lemon Crème.
4 large firm ripe pears, peeled, cored, and thinly sliced
2½ cups cranberries, thawed if frozen
Juice and finely grated peel of 1 medium orange
¼ teaspoon salt
¼ teaspoon freshly grated nutmeg
¼ teaspoon ground ginger
¾ cup (6 ounces) thawed frozen pear or apple juice concentrate or mixed pear,
apple, and peach juice concentrate
2 tablespoons cornstarch
2 cups reduced-fat granola (no more than 4 percent calories from fat), such as
Health Valley
Preheat the oven to 400°F. Combine the pears, cranberries, orange juice, orange
peel, salt, nutmeg, and ginger in a large bowl. Stir the juice concentrate and
cornstarch together in a small bowl. Immediately pour into the fruit mixture and
blend well. Pour into a 2-quart nonstick baking dish (or a baking dish lined with
parchment). Bake for 20 minutes. Remove from the oven and reduce the heat to
350°F. Stir the fruit mixture thoroughly and sprinkle the granola evenly on top.
Bake for 20 to 30 minutes or until the fruit is soft. Serve warm.
MAKES 8 SERVINGS
Per serving: 201 calories, 3 g protein, 51 g carbohydrates, 27 g sugar, 1 g total
fat, 2% calories from fat, 0 mg cholesterol, 7 g fiber, 101 mg sodium
Lemon Crème
This simply delicious crème can be used as a pudding or a topping for fruit or
cake. All you need are three ingredients (you use the lemon peel and the juice)
and your blender.
1 package (12.3 ounces) reduced-fat extra-firm silken tofu, crumbled
⅓ cup Grade A (light) maple syrup or agave nectar
3 tablespoons fresh lemon juice
1 tablespoon grated lemon peel
Blend the tofu, maple syrup or agave nectar, lemon juice, and lemon peel until
very smooth in a blender or food processor (or place in a bowl and use a hand-
held blender). Refrigerate in a covered container until chilled.
MAKES 1¾ CUPS (4 SERVINGS)
Per serving: 106 calories, 6 g protein, 20 g carbohydrates, 17 g sugar, 1 g total
fat, 5% calories from fat, 0 mg cholesterol, 0.5 g fiber, 88 mg sodium
Variation
Lemon-Ginger Crème: Fold in ¼ cup finely minced crystallized ginger.
Pineapple Sherbet Pops
You can make this variation on a favorite summer treat with a blender and just
six ingredients.
1 package (12.3 ounces) reduced-fat firm or extra-firm silken tofu
3 tablespoons agave nectar or ⅓ cup sugar
4 teaspoons lemon juice
¾ teaspoon vanilla extract
1 can (19 ounces) juice-packed unsweetened crushed pineapple
¼ teaspoon coconut extract
Place the tofu, agave nectar or sugar, lemon juice, vanilla, pineapple (with juice),
and coconut extract in a blender and process until smooth. Pour into 18 small ice
pop molds, insert sticks, and freeze until solid. To serve, dip the bottoms of the
molds in hot water for a few seconds so the pops slide out easily.
MAKES 18 SERVINGS
Per popsicle: 30 calories, 2 g protein, 6 g carbohydrates, 6 g sugar, 0.5 g total
fat, 4% calories from fat, 0 mg cholesterol, 0.5 g fiber, 19 mg sodium
Berry Mousse
This is so easy that it’s hardly a recipe! Your blender does most of the work. This
can be eaten as a pudding or used as a topping for fruit.
1 package (12.3 ounces) reduced-fat extra-firm silken tofu, crumbled
2¾ cups thawed frozen unsweetened berries of choice
3 tablespoons sugar or 2 tablespoons agave nectar
1 tablespoon berry liqueur (optional)
Blend the tofu, berries, sugar or agave nectar, and liqueur, if desired, in a blender
or food processor until smooth. Spoon into 4 pudding dishes and refrigerate until
chilled.
MAKES 4 SERVINGS
Per serving: 123 calories, 7 g protein, 24 g carbohydrates, 17 g sugar, 1 g total
fat, 5% calories from fat, 0 mg cholesterol, 3 g fiber, 89 mg sodium
Orange-Applesauce Date Cake
This easy lunchbox cake is moist and delicious—and even better the next day.
The applesauce replaces both eggs and fat.
1 cup unsweetened smooth applesauce
1 tablespoon lemon juice
2 tablespoons water
1 tablespoon grated orange peel
1 cup whole wheat pastry flour (not regular whole wheat flour)
½ cup brown sugar
¼ cup oat flour (oatmeal ground in a dry blender or electric coffee mill) or
barley flour
½ teaspoon ground cinnamon
¼ teaspoon salt
⅛ teaspoon ground nutmeg
⅛ teaspoon ground allspice
1 teaspoon baking soda
1 cup chopped pitted dates
Preheat the oven to 350°F. Place the applesauce, lemon juice, and 2 tablespoons
water in a small saucepan over medium heat and warm slowly. Add the orange
peel.
Mix the pastry flour, brown sugar, oat or barley flour, cinnamon, salt, nutmeg,
and allspice in a medium bowl.
Stir the baking soda into the applesauce mixture (it will foam up). Pour
immediately into the flour mixture and stir briefly but thoroughly.
Add the dates and mix briefly. Scoop the batter into a nonstick 9" × 9" cake pan,
smooth the top, and bake for 10 minutes. Reduce the heat to 325°F and bake for
25 to 30 minutes or until it tests done with a cake tester. Transfer to a rack and
cool completely. Make 2 evenly spaced cuts through the cake vertically, then
horizontally, to make 9 squares.
MAKES 9 SERVINGS
Per serving: 169 calories, 3 g protein, 41 g carbohydrates, 24 g sugar, 0.5 g
total fat, 2% calories from fat, 0 mg cholesterol, 4 g fiber, 199 mg sodium
NOTES
INTRODUCTION
1
A. S. Nicholson et al., “Toward Improved Management of NIDDM: A
Randomized, Controlled, Pilot Intervention Using a Low-Fat, Vegetarian
Diet,” Preventive Medicine 29 (1999): 87–91.
2
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
Intervention on Body Weight, Metabolism, and Insulin Sensitivity,” American
Journal of Medicine 118 (2005): 991–97.
CHAPTER 1
1
M. Knip et al., “Environmental Triggers and Determinants of Type 1
Diabetes,” Diabetes 54, suppl 2 (December 2005): S125–36.
CHAPTER 2
1
T. Kuzuya, “Prevalence of Diabetes Mellitus in Japan Compiled from
Literature,” Diabetes Research and Clinical Practice 24, suppl (1994): S15–
21.
2
H. P. Himsworth, “The Dietetic Factor Determining the Glucose Tolerance
and Sensitivity to Insulin of Healthy Men,” Clinical Science 2 (1935): 67–94.
3
D. B. Stone and W. E. Connor, “The Prolonged Effects of a Low-Cholesterol,
High-Carbohydrate Diet upon the Serum Lipids in Diabetic Patients,”
Diabetes 12 (1963): 127–32.
4
J. W. Anderson and K. Ward, “High-Carbohydrate, High-Fiber Diets for
Insulin-Treated Men with Diabetes Mellitus,” American Journal of Clinical
Nutrition 32 (1979): 2312–21.
5
R. J. Barnard, T. Jung, and S. B. Inkeles, “Diet and Exercise in the Treatment
of NIDDM: The Need for Early Emphasis,” Diabetes Care 17 (1994): 1469–
72.
6
A. S. Nicholson et al., “Toward Improved Management of NIDDM: A
Randomized, Controlled, Pilot Intervention Using a Low-Fat, Vegetarian
Diet,” Preventive Medicine 29 (1999): 87–91.
7
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
Intervention on Body Weight, Metabolism, and Insulin Sensitivity,” American
Journal of Medicine 118 (2005): 991–97.
8
A. E. Bunner, C. L. Wells, J. Gonzales, U. Agarwal, E. Bayat, N. D. Barnard.
A dietary intervention for chronic diabetic neuropathy pain: a randomized
controlled pilot study. Nutrition & Diabetes 2015 May 26;5:e158. doi:
10.1038/nutd.2015.8.
9
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
Intervention on Body Weight, Metabolism, and Insulin Sensitivity,” American
Journal of Medicine 118 (2005): 991–97.
10
I. M. Stratton, A. L. Adler, and H. A. Neil, “Association of Glycaemia with
Macrovascular and Microvascular Complications of Type 2 Diabetes
(UKPDS 35): Prospective Observational Study,” British Medical Journal 321
(2000): 405–12.
11
UK Prospective Diabetes Study (UKPDS) Group, “Effect of Intensive Blood-
Glucose Control with Metformin on Complications in Overweight Patients
with Type 2 Diabetes (UKPDS 34),” Lancet 352 (1998): 854–65.
12
D. Ornish et al., “Can Lifestyle Changes Reverse Coronary Heart Disease?”
Lancet 336 (1990): 129–33.
13
————, “Intensive Lifestyle Changes for Reversal of Coronary Heart
Disease,” Journal of the American Medical Association 280 (1998): 2001–7.
14
Y. Yokoyama, K. Nishimura, N. D. Barnard, et al. Vegetarian diets and blood
pressure: a meta-analysis. JAMA International Medicine 2014;174(4):577–87.
15
K. F. Petersen et al., “Impaired Mitochondrial Activity in the Insulin-
Resistant Offspring of Patients with Type 2 Diabetes,” New England Journal
of Medicine 350 (2004): 664–71.
16
Ibid.
17
L. M. Sparks et al., “A High-Fat Diet Coordinately Downregulates Genes
Required for Mitochondrial Oxidative Phosphorylation in Skeletal Muscle,”
Diabetes 54 (2005): 1926–33.
18
A. V. Greco et al, “Insulin Resistance in Morbid Obesity: Reversal with
Intramyocellular Fat Depletion,” Diabetes 52 (2002): 144–51.
19
L. M. Goff et al., “Veganism and Its Relationship with Insulin Resistance and
Intramyocellular Lipid,” European Journal of Clinical Nutrition 59 (2005):
291–8.
CHAPTER 3
1
D. M. Nathan et al. and the Diabetes Control and Complications
Trial/Epidemiology of Diabetes Interventions and Complications
(DCCT/EDIC) Study Research Group, “Intensive Diabetes Treatment and
Cardiovascular Disease in Patients with type 1 Diabetes,” New England
Journal of Medicine 353 (2005): 2643–53.
2
Diabetes Control and Complications Trial Research Group, “The Effect of
Intensive Treatment of Diabetes on the Development and Progression of
Long-Term Complications in Insulin-Dependent Diabetes Mellitus,” New
England Journal of Medicine 329 (1993): 977–86.
3
E. L. Knight et al., “The Impact of Protein Intake on Renal Function Decline
in Women with Normal Renal Function or Mild Renal Insufficiency,” Annals
of Internal Medicine 138 (2003): 460–7.
4
J. Karjalainen et al., “A Bovine Albumin Peptide as a Possible Trigger of
Insulin-Dependent Diabetes Mellitus,” New England Journal of Medicine 327
(1992): 302–7.
5
A. C. Alting, R. G. J. M. Meijer, and E. C. H. van Beresteijn, “Incomplete
elimination of the ABBOS Epitope of Bovine Serum Albumin under
Simulated Gastrointestinal Conditions of Infants,” Diabetes Care 20 (1997):
875–80.
6
D. Hammond-McKibben and H. M. Dosch, “Cow’s Milk, Bovine Serum
Albumin, and IDDM: Can We Settle the Controversies?” Diabetes Care 20
(1997): 897–901.
7
Ibid.
8
American Academy of Pediatrics Work Group on Cow’s Milk Protein and
Diabetes Mellitus, “Infant Feeding Practices and Their Possible Relationship
to the Etiology of Diabetes Mellitus,” Pediatrics 94 (1994): 752–4.
9
H. K. Akerblom et al., “Dietary Manipulation of Beta Cell Autoimmunity in
Infants at Increased Risk of Type 1 Diabetes: A Pilot Study,” Diabetologia 48
(2005): 829–37.
10
P. S. Clyne and A. Kulczycki Jr. Human breast milk contains bovine IgG:
relationship to infant colic?” Pediatrics 87 (1991): 439–44.
11
K. Sadeharju et al., “Enterovirus Infections as a Risk Factor for Type 1
Diabetes: Virus Analyses in a Dietary Intervention Trial,” Clinical and
Experimental Immunology 132 (2003): 271–7.
CHAPTER 4
1
L. M. Goff et al., “Veganism and Its Relationship with Insulin Resistance and
Intramyocellular Lipid,” European Journal of Clinical Nutrition 59 (2005):
291–8.
2
E.C. Rizos, E.E. Ntzani, E. Bika, et al. Association between omega-3 fatty
acid supplementation and risk of major cardiovascular disease events. JAMA.
2012;308:1024-33.
3
S. M. Kwak, S. K. Myung, Y. J. Lee, H. G. Seo; Korean Meta-analysis study
Group... Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid
and docosahexaenoic acid) in the secondary prevention of cardiovascular
disease. Archives of Internal Medicine 2012; 172(9):686–94.
4
S. Tonstad, T. Butler, R. Yan, G. E. Fraser. Type of vegetarian diet, body
weight, and prevanence of type 2 diabetes. Diabetes Care. 2009;32:791–96.
5
M. Kaushik, D. Mozaffarian, D. Spiegelman, et al. Long-chain omega-3 fatty
acids, fish intake, and the risk of type 2 diabetes mellitus. American Journal
of Clinical Nutrition 2009;90:613–20; N. D. Barnard, J. Cohen, D. J. Jenkins,
et al. A low-fat, vegan diet improves glycemic control and cardiovascular risk
factors in a randomized clinical trial in individuals with type 2 diabetes.
Diabetes Care 2006;29:1777–83.
6
N. D. Barnard, J. Cohen, D. J. Jenkins, G. Turner-McGrievy, L. Gloede, B.
Jaster, K. Seidl, A. A. Green, S. Talpers. A low-fat, vegan diet improves
glycemic control and cardiovascular risk factors in a randomized clinical trial
in individuals with type 2 diabetes. Diabetes Care 2006;29:1777–83.
7
Y. Papanikolaou et al., “Bean Consumption by Adults Is Associated with a
More Nutrient Dense Diet and a Reduced Risk of Obesity,” presented at the
Experimental Biology Conference, April 1–5, 2006, San Francisco, CA.
8
V. L. Fulgoni et al., “Bean Consumption by Children Is Associated with
Better Nutrient Intake and Lower Body Weights and Waist Circumferences,”
presented at the Experimental Biology Conference, April 1–5, 2006, San
Francisco, CA.
9
S. J. Kim, R. J. de Souza, V. L. Choo, et al. Effect of dietary pulse
consumption on body weight : a systematic review and meta-analysis of
randomized controlled trials. Am J Clin Nutr;2016:103:1213-23.
10
V. Ha, J. L. Sievenpiper, R. J. de Souza, et al. Effect of dietary pulse intake
on established lipid targets for cardiovascular risk reduction: a systematic
review and meta-analysis of randomized controlled trials. Canad Med Asso J.
2014;186:e252-62.
11
D. G. Bailey, G. Dresser, M. O. Arnold. Grapefruit-medicaitonn interactions:
forbidden fruit or avoidable consequences? CMAJ. 2013;185:309-16.
12
E. L. Knight et al., “The Impact of Protein Intake on Renal Function Decline
in Women with Normal Renal Function or Mild Renal Insufficiency,” Annals
of Internal Medicine 138 (2003): 460–7.
13
E. Giovannucci et al., “Calcium and Fructose Intake in Relation to Risk of
Prostate Cancer,” Cancer Research 58 (1998): 442–7.
14
J. M. Chan et al., “Dairy Products, Calcium, and Prostate Cancer Risk in the
Physicians’ Health Study,” American Journal of Clinical Nutrition 74 (2001):
549–54.
15
X. Gao, M. P. LaValley, K. L. Tucker. Prospective studies of dairy product
and calcium intakes and prostate cancer risk: a meta-analysis. Journal of the
National Cancer Institute 2005 dec 7;97(23):1768–77.
16
K. M. Wilson, e. L. Giovannucci, L. A. Mucci. Lifestyle and dietary factors
in the prevention of lethal prostate cancer. Asian Journal of Andrology.
2012;14:265–74.
17
H. L. Newmark, r. P. Heaney. Dairy products and prostate cancer risk.
Nutrition and Cancer 2010;62(3):297–99.
18
S. C. Larsson, N. Orsini, and A. Wolk, “Milk, Milk Products and Lactose
Intake and Ovarian Cancer Risk: A Meta-Analysis of Epidemiological
Studies,” International Journal of Cancer 118 (2006): 431–41.
19
J. M. Genkinger et al., “Dairy Products and Ovarian Cancer: A Pooled
Analysis of 12 Cohort studies,” Cancer Epidemiology Biomarkers &
Prevention 15 (2006): 364–72.
20
B. Qin, P. G. Moorman, A. J. Alberg, et al. Dairy, calcium, vitamin D and
ovarian cancer risk in African-American women. British Journal of Cancer
2016; 2016;115(9):1122–30.
21
D. J. Jenkins et al., “Glycemic Index of Foods: A Physiological Basis for
Carbohydrate Exchange,” American Journal of Clinical Nutrition 34 (1981):
362–6.
22
Ibid.
23
J. Brand-Miller et al., “Low-Glycemic Index Diets in the Management of
Diabetes,” Diabetes Care 26 (2003): 2261–7.
24
N. C. Howarth, e. Saltzman, and s. B. Roberts, “Dietary Fiber and Weight
regulation,” Nutrition Reviews 59 (2001): 129–39.
25
N. D. Barnard et al., “the Effects of a Low-Fat, Plant-Based Dietary
Intervention on Body Weight, Metabolism, and Insulin Sensitivity,” American
Journal of Medicine 118 (2005): 991–97.
26
M. G. Crane and c. Sample,” “Regression of Diabetic Neuropathy with Total
Vegetarian (Vegan) Diet,” Journal of Nutritional Medicine 4 (1994): 431–9.
27
A. E. Bunner, c. L. Wells, J. Gonzales, u. Agarwal, E. Bayat, N. D. Barnard.
A dietary intervention for chronic diabetic neuropathy pain: a randomized
controlled pilot study. Nutrition & Diabetes 2015 May 26;5:e158. doi:
10.1038/nutd.2015.8.
28
G. M. Turner-McGrievy, et al. Effects of a low-fat, vegan diet and a step II
diet on macro- and micronutrient intakes in overweight, postmenopausal
women, Nutrition 20 (2004): 738–46.
29
E. L. Knight et al., “The Impact of Protein Intake on Renal Function Decline
in Women with Normal Renal Function or Mild Renal Insufficiency,” Annals
of Internal Medicine 138 (2003): 460–7.
30
V. Melina, W. Craig, s. Levin. Position of the Academy of Nutrition and
Dietetics: vegetarian diets. Journal of the Academy of Nutrition and Dietetics
2016;116:1970–80.
31
E. C. Westman et al. Effect of a 6-month adherence to a very low
carbohydrate diet program. American Journal of Medicine 113 (2002): 30–36.
CHAPTER 6
1
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
Intervention on Body Weight, Metabolism, and Insulin Sensitivity,” American
Journal of Medicine 118 (2005): 991–97.
2
N. C. Howarth, e. Saltzman, and s. B. Roberts, “Dietary Fiber and Weight
Regulation,” Nutrition Reviews 59 (2001): 129–39.
3
Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary Intervention.”
4
J. A. Vernarelli, d. C. Mitchell, B. J. Rolls, t. J. Hartman. Dietary energy
density is associated with obesity and other biomarkers of chronic disease in
us adults. European Journal Nutrition 2015;54:59–65.
5
A. M. Dattilo and P. M. Kris-Etherton, “Effects of Weight Reduction on
Blood Lipids and Lipoproteins: A Meta-Analysis,” American Journal of
Clinical Nutrition 56 (1992): 320–8.
6
E. C. Westman et al., “Effect of a 6-Month Adherence to a Very Low
Carbohydrate Diet Program,” American Journal of Medicine 113 (2002): 30–
6.
7
W. S. Yancy et al., “A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat
Diet to Treat Obesity and Hyperlipidemia,” Annals of Internal Medicine 130
(2004): 769–77.
8
E. L. Knight et al., “The Impact of Protein Intake on Renal Function Decline
in Women with Normal Renal Function or Mild Renal Insufficiency,”
American Journal of Medicine 118 (2005): 460–7.
9
J. Coresh et al., “Prevalence of chronic Kidney Disease and Decreased
Kidney Function in the Adult us Population: Third National Health and
Nutrition Examination Survey,” American Journal of Kidney Diseases 41
(2003): 1–12.
10
K. D. Hall, t. Bemis, r. Brychta, et al. Calorie for calorie, dietary fat
restriction results in more body fat loss than carbohydrate restriction in people
with obesity. Cell Metabolism. 2015;22:427–36.
CHAPTER 7
1
G. B. Bolli and J. E. Gerich, “The ‘Dawn Phenomenon’—A Common
Occurrence in Both Non-Insulin-Dependent and Insulin-Dependent Diabetes
Mellitus,” New England Journal of Medicine 310 (1984): 746–50.
2
E. Selvin et al., “Meta-analysis: A1C and Cardiovascular Disease in Diabetes
Mellitus,” Annals of Internal Medicine 141 (2004): 421–31.
3
National Cholesterol Education Program, “Third Report of the National
Cholesterol Education Program (NCEP) Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult
Treatment Panel III) Final Report,” Circulation 106 (2002): 3143–421.
4
S. M. Grundy, et al. “Implications of Recent Clinical Trials for the National
Cholesterol Education Program Adult Treatment Panel III Guidelines,”
Circulation 110 (2004): 227–39.
5
American Diabetes Association, 2017
CHAPTER 9
1
M. R. Yeomans et al., “Effects of Nalmefene on Feeding in Humans,”
Psychopharmacology 100 (1990): 426–32.
2
D. J. Jenkins et al., “Low-Glycemic Index Diet in Hyperlipidemia: Use of
Traditional Starchy Foods,” American Journal of Clinical Nutrition 46
(1987): 66–71.
CHAPTER 10
1
J. Hlebowicz, A. Hlebowicz, s. Lindstedt, et al. Effects of 1 and 3 g cinnamon
on gastric emptying, satiety, and postprandial blood glucose, insulin, glucose-
dependent insulinotropic polypeptide, glucagon-like peptide 1, and ghrelin
concentrations in healthy subjects. American Journal of Clinical Nutrition
2009; 89:815–21.
2
R. M. van dam, F. B. Hu, L. Rosenberg, s. Krishnan, J. R. Palmer. Dietary
calcium and magnesium, major food sources, and risk of type 2 diabetes in
U.S. black women. Diabetes Care 2006 Oct;29(10):2238–43.
3
W. Mertz, “Chromium Occurrence and Function in Biological systems,”
Physiological Reviews 49 (1969): 163–239.
4
K. N. Jeejeebhoy et al., “Chromium Deficiency, Glucose Intolerance, and
Neuropathy Reversed by Chromium Supplementation in a Patient Receiving
Long-term Total Parenteral Nutrition,” American Journal of Clinical
Nutrition 30 (1977): 531–8.
5
G. W. Landman, h. J. Bilo, s. t. Houweling, N. Kleefstra. Chromium does not
belong in the diabetes treatment arsenal: current evidence and future
perspectives. World Journal of Diabetes 2014;5:160–64.
6
S. Jacob et al., “Oral Administration of RAC-Alpha-Lipoic Acid Modulates
Insulin Sensitivity in Patients with Type-2 Diabetes Mellitus: A Placebo-
Controlled Pilot Trial,” Free Radical Biology & Medicine 27 (1999): 309–14.
7
D. Ziegler, P. A. Low, W. J. Litchy, et al. Efficacy and safety of antioxidant
treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the
NATHAN 1 trial. Diabetes Care 2011;34(9):2054–60.
CHAPTER 11
1
W. C. Knowler et al., “Reduction in the Incidence of Type 2 Diabetes with
Lifestyle Intervention or Metformin,” New England Journal of Medicine 346
(2002): 393–403.
2
D. E. Thomas, e. J. Elliott, G. A. Naughton. Exercise for type 2 diabetes
mellitus. Cochrane Database System Review 2006 Jul 19;(3):cd002968.
3
N. G. Boulé et al., “Effects of Exercise on Glycemic Control and Body Mass
in Type 2 Diabetes Mellitus: A Meta-Analysis of Controlled Clinical Trials,”
Journal of the American Medical Association 286 (2001): 1218–27.
4
G. Hu et al., “Physical Activity, Cardiovascular Risk Factors, and Mortality
among Finnish Adults with Diabetes,” Diabetes Care 28 (2005): 799–805.
5
————, “Leisure Time, Occupational, and Commuting Physical Activity
and the Risk of Stroke,” Stroke 36 (2005): 1994–9.
6
Diabetes Research in Children Network (DirecNet) study Group. The effects
of aerobic exercise on glucose and counterregulatory hormone concentrations
in children with type 1 diabetes. Diabetes Care 29 (2006): 20–25.
CHAPTER 12
1
N. D. Barnard, L. W. Scherwitz, and D. Ornish. “Adherence and
Acceptability of a Low-Fat, Vegetarian Diet among Patients with Cardiac
Disease,” Journal of Cardiopulmonary Rehabilitation 12 (1992): 423–31.
2
D. Ornish et al., “Can Lifestyle Changes Reverse Coronary Heart Disease?”
Lancet 336 (1990): 129–33.
3
————, “Intensive Lifestyle Changes for Reversal of Coronary Heart
Disease.”
4
N. D. Barnard, A. Akhtar, and A. Nicholson, “Factors That Facilitate
Compliance to Lower Fat Intake,” Archives of Family Medicine 4 (1995):
153–8.
5
C. B. Esselstyn Jr., “Updating a 12-Year Experience with Arrest and Reversal
Therapy for Coronary Heart Disease (an Overdue Requiem for Palliative
Cardiology),” American Journal of Cardiology 84 (1999): 339–41.
6
D. J. Jenkins, A. Mirrahimi, K. Srichaikul, et al. Soy protein reduces serum
cholesterol by both intrinsic and food displacement mechanisms. Journal of
Nutrition 2010;140(12):2302s–2311s.
7
P. M. Kris-Etherton, F. B. Hu, E. Ros, J. Sabaté. The role of tree nuts and
peanuts in the prevention of coronary heart disease: multiple potential
mechanisms. Journal of Nutrition 2008 Sep;138(9):1746s–1751s.
8
D. J. Jenkins et al., “Direct Comparison of a Dietary Portfolio of Cholesterol-
Lowering Foods with a Statin in Hypercholesterolemic Participants,”
American Journal of Clinical Nutrition 81 (2005): 380–7.
9
A. Poobalan, L. Aucott, W. C. Smith, A. Avenell, r. Jung, J. Broom, A. M.
Grant. Effects of weight loss in overweight/obese individuals and long-term
lipid outcomes—a systematic review. Obesity Review 2004;5(1):43–50.
10
S. Berkow and N. D. Barnard, “Blood Pressure Regulation and Vegetarian
Diets,” Nutrition Reviews 63 (2005): 1–8.
CHAPTER 13
1
M. G. Crane, “Sample c. Regression of Diabetic Neuropathy with Total
Vegetarian (Vegan) Diet,” Journal of Nutritional Medicine 4 (1994): 431–9.
2
D. Ziegler. Efficacy and safety of antioxidant treatment.
3
D. F. Horrobin, “Essential Fatty Acids in the Management of Impaired Nerve
Function in Diabetes,” Diabetes 46, suppl 2 (1997): S90–93.
4
A. A. Sima. Acetyl-L-carnitine in diabetic polyneuropathy: experimental and
clinical data. CNS Drugs 2007;21 suppl 1:13–23; discussion 45–6.
5
I. De Leeuw et al., “Long Term Magnesium Supplementation Influences
Favourably the Natural Evolution of Neuropathy in Mg-Depleted type 1
Diabetic Patients (T1dm),” Magnesium Research 17 (2004): 109–14.
6
M. Lu et al., “Prospective Study of Dietary Fat and Risk of Cataract
Extraction among US Women,” American Journal of Epidemiology 161
(2005): 948–59.
7
N. Karas-Kuzelicki, V. Pfeifer, J. Lukac-Bajalo. Synergistic effect of high
lactase activity genotype and galactose-1-phosphate uridyl transferase
(GALT) mutations on idiopathic presenile cataract formation. Clinical
Biochemistry 2008 Jul;41(10-11):869–74.
8
L. Ma, X. M. Lin. Effects of lutein and zeaxanthin on aspects of eye health.
Journal of the Science of Food and Agriculture 2010 Jan 15;90(1):2–12. doi:
10.1002/jsfa.3785.
9
R. G. Cumming, P. Mitchell, and W. Smith, “Diet and Cataract: The Blue
Mountains Eye study,” Ophthalmology 107 (2000): 450–6.
10
M. S. Morris et al., “Moderate Alcoholic Beverage Intake and Early Nuclear
and Cortical Lens Opacities,” Ophthalmic Epidemiology 11 (2004): 53–65.
11
L. Azadbakht, s. Atabak, A. Esmaillzadeh. Soy protein intake, cardiorenal
indices, and c-reactive protein in type 2 diabetes with nephropathy: a
longitudinal randomized clinical trial. Diabetes Care 2008 Apr;31(4):648–54.
12
Y. Yokoyama, K. Nishimura, N. D. Barnard, et al. Vegetarian diets and blood
pressure: a meta-analysis. JAMA International Medicine 2014;174(4):577–87.
ABOUT THE AUTHOR
Neal Barnard, MD, FACC, is the founder and president of the Physicians
Committee for Responsible Medicine. He has authored more than 70 scientific
publications, as well as 19 books, including the bestsellers Power Foods for the
Brain, 21-Day Weight Loss Kickstart, and Dr. Neal Barnard’s Program for
Reversing Diabetes, and the new Dr. Neal Barnard's Cookbook for Reversing
Diabetes. Dr. Barnard is a frequent lecturer appearing throughout the world and
an adjunct professor of medicine at the George Washington University School of
Medicine. He lives in Washington, DC.
This book is intended as a reference volume only, not as a medical manual.
The information given here is designed to help you make informed decisions about your health. It is not
intended as a substitute for any treatment that may have been prescribed by your doctor. If you suspect that
you have a medical problem, we urge you to seek competent medical help.
Mention of specific companies, organizations, or authorities in this book does not imply endorsement by the
publisher, nor does mention of specific companies, organizations, or authorities imply that they endorse this
book.
Internet addresses and telephone numbers given in this book were accurate at the time it went to press.
First published in hardcover by Rodale Inc. in December 2006.
First published in paperback by Rodale Inc. in February 2008.
© 2017, 2008, 2006 by Neal D. Barnard, MD
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any other information storage and
retrieval system, without the written permission of the publisher.
Book design by Christopher Rhoads
Library of Congress Cataloging-in-Publication Data is on file with the publisher.
ISBN 978–1–63565–127–0 paperback
ISBN 978–1–63565–128–7 e-book
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